


ift 



LIBRARY O F CONG RESS. 

Chap,...:._. Copyright No. 



Shell. 



Jai 



UNITED STATES OF AMERICA. 



RETINOSCOPY 

(SHADOW TEST) 



THOR1NGTON 



Reviews of the 
First Edition of 



Thorington's Retinoscopy, 



From " The Annals of Ophthalmology," St. Louis, Mo. 

" Retinoscopy has come to stay. It is not a fad, neither a fashion. It is scientific, 
and withal so eminently practical in its application as to commend it to every think- 
ing worker in ophthalmology. The tendency in the medicine of to-day is toward 
objective methods. An objective method must possess two attributes : exactness 
and absolute independence of the patient's testimony. In addition to these qualities, 
an objective method must, if it is to meet with general acceptance, be easy of applica- 
tion. Ophthalmoscopy and ophthalmometry are but relatively exact in refractive 
work, seeing which the trial case has held its supremacy up to date ; nor would we 
wish to relegate it to the background. With a patient whose testimony is trust- 
worthy exact results are thus obtainable, but it requires the most intelligent co-opera- 
tion on the part of the examined. If, however, there be but the least departure from 
the conditions essential to close work with the test lenses,— as, for instance, with foreign- 
ers, illiterates, children, partial amblyopics, or mental astigmatics, — retinoscopy 
stands ready to furnish a verdict from which there can be no appeal, when one has 
learned to properly interpret the movements observed in the pupillary area. It is to 
the elucidation of these latter movements as observed through a plane mirror at a 
distance of one meter that Dr. Thorington devotes himself in the volume before us. 
The treatment of the subject is so beautifully simple that one who runs may read." 

From " The Journal of the American Medical Association," Chicago, III. 

" The author of this well-written little book has very satisfactorily described the 
most approved methods of retinoscopy. The work is especially valuable in that for a 
great part it details the results of personal investigation of such a well-known 
authority on this subject as Dr. Thorington. Oculists accustomed to casually use 
retinoscopy as practised in the old way, with the concave mirror or with the ophthal- 
moscopic mirror, will be surprised to note the marked evolution of the modus oper- 
andi of this test as developed by Drs. Jackson and Thorington. With perfected in- 
struments and strict attention to arrangement of light, distance, and other details, a 
surprising degree of proficiency and accuracy is possible. Any one pursuing the 
modern methods of retinoscopy will soon be convinced of its superiority over all 
other objective tests, and every worker in ophthalmology realizes the necessity of at 
least one reliable objective method of refraction." 

From " The New Orleans Medical and Surgical Journal," New Orleans, La. 

" We have nothing but a good word for this little book. It seems to fulfil well 
the purpose intended. It gives a brief, clear description of the means and manner of 
retinoscopy, together with the principles or natural laws upon which it is founded. 
The author has done well in selecting the method he thinks best and simplest, and has 
confined himself to it, so that the student will have no difficulty or confusion in fol- 
lowing the manual step by step, and learning to put in practice for himself what is 
described in the pages. This once accomplished he can readily, if he becomes con- 
vinced of its usefulness, acquire the variations and refinements upon this mode of 
examination." 

From " The New York Medical Journal," New York. 

"This little book presents as simple and practical a description of the shadow 
lest as exists in our language." 

From "The Medical Record," New York. 

' A practical knowledge of retinoscopy may be gained by the perusal of the work. 
The pages are well'illustrated." 

From "The Scottish Medical and Surgical Journal," Edinburgh, Scotland. 

" Dr. Thorington's lucid text is accompanied by twenty-four good illustrations, 
and on every page one notes that careful attention has been paid to little details of 
manipulation which stamp the writer as a practical teacher." 



From " The Homeopathic Eye, Ear, and Throat Journal," New York. 

" A practical and useful book. This is one of the most concise and clearest ex- 
planations of this subject we have seen. Retinoscopy is one of the most valuable aids 
we have in refractive work." 

From "The Denver Medical Times," Denver, Col. 

" His directions and descriptions are exceptionally clear and concise, and the 
little book he has written, we think, will be helpful to every physician who is inter- 
ested in the fitting of glasses." 

From " The Chicago Medical Recorder," Chicago, III. 

" This little book is the most practical and complete exposition of the value and 
application of the shadow test in determining refractive errors with which we have 
any acquaintance. The illustrations, directions, advice,- and general information in 
the book are all admirable." 

From "The Post=Graduate," New York. 

" This work on retinoscopy is divided into six chapters and an index. As stated 
in the preface, it is an abstract of the author's previous writings and lectures on 
retinoscopy, delivered at the Philadelphia Polyclinic. It is intended for college 
students and post-graduates, yet is sufficiently complete for the use of the ophthal- 
mologist. Retinoscopy has been selected as the name of the test, as it is the retina in 
its relative position to the refractive media which is studied. Skiascopy and skia- 
graphy are therefore discarded as misleading. To all those who are interested in 
this test for the determination of refraction we commend the work." 

From "The Philadelphia Polyclinic," Philadelphia. 

" We take pleasure in commending this concise statement of the methods to be 
employed in the routine use of a most valuable objective means of determining the 
errors of refraction. The student is told in simple English how to proceed in the 
examination." 

From "The Boston Medical and Surgical Journal," Boston, Mass. 

" This little manual is certainly the clearest exposition of this method of estimat- 
ing refraction of the eye that has yet been published. The methods described are not 
so complicated as those taught in some other handbooks. The text is clear, and the 
illustrations serve the purposes for which they are designed admirablv. Taken 
altogether, it is the most practicable handbook on retinoscopy yet published." 



"We most emphatically recommend this little book to the beginner in the study 
of this method of determining refraction. The title is an index of the character of the 
text. It is positive, exact, practical. The aim of the author has been to present 
facts, and in as small space as possible. He has succeeded absolutely. The average 
work on this subject is, to the beginner, somewhat confusing, from the amount of 
theory presented— theory which is not always clear to the student. This has been 
avoided in the present case. Little, if any, theory is included, and the monograph is 
a series of categorical statements — clear, precise, and sufficient. 



* * *. The price of this book (second edition, revised 
and enlarged) is $1.00 net, upon receipt of which it will 
be sent postpaid to any address. It may be obtained from 
the publishers or through any bookseller or dealer in 
opticians' supplies. 



RETINOSCOPY 



(OR SHADOW TEST) 



DETERMINATION OF REFRACTION AT ONE METER 
DISTANCE, WITH THE PLANE MIRROR 



JAMES THORINGTON, M. D. 



jphthalmolocist to the \ 
l for feeble-minded children; ophthalmologic 
<phanage; lecturer in the Philadelphia manu. 
schools, 1896-97, on the anatomy, physiology, 
and care of the eyes ; resident physician and sur- 
geon panama railroad co. at colon (aspin- 
wall), isthmus of panama, 1882-1889, etc. 



SECOND EDITION, REVISED AND ENLARGED 



THIRTY-EIGHT ILLUSTRATIONS 

TWELVE OF WHICH ARE COLORED 



PHILADELPHIA 

P. BLAKISTON, SON 



_ I OI2 WALNUT STREET 

2nd COPY, i898 



1898. 



__i 







<-*> 



5031 



Copyright, 1898, by James Thorington, M.D. 



Press of Wm. F. Fell &. Co., 
1220-24 Sansom St., 



THIS BOOK IS AFFECTIONATELY DEDICATED TO THE 
MEMORY OF 

FELIX A. BETTELHEIM, PH.D., M.D., 

MY FRIEND AND ASSOCIATE DURING HIS SIX YEARS' RESI- 
DENCE, AS SURGEON OF THE PANAMA RAILROAD 
COMPANY, AT PANAMA. 



PREFACE TO THE SECOND EDITION. 



The first edition of this book was published in 
March, 1897, and it is indeed gratifying to the 
author that the work has found such favor as to call 
for a second in so short a time. 

To make this edition more lucid than the first, 
the writer has carefully reviewed the original text 
and made some changes in the phraseology, and at 
the same time has added many new illustrations, 
twelve of which are in colors. 

A description and drawings of three lenses, sug- 
gested by the author for the study of the scissor 
movement, conic cornea, and spheric aberration on 
the schematic eye, have also been inserted. 

120 S. Eighteenth St., Philadelphia, Pa., 
February, i8g8. 



PREFACE TO THE FIRST EDITION. 



At the earnest solicitation of many students and 
friends, this book is presented as an abstract of the 
author's previous writings and lectures on Retinos- 
copy, delivered during the winter course on Oph- 
thalmology, at the Philadelphia Polyclinic. 

In presenting a manual of this kind the writer does 
not presume to detract from the writings or teach- 
ings of others, or the excellent work on Skiascopy, 
by his friend and colleague, Dr. E. Jackson ; but 
wishes to elucidate in as concise a manner and few 
words as possible the method of applying retinos- 
copy, which has given most satisfaction at his hands. 

While intended for college students and post- 
graduates, yet there is ample material given where- 
by the ophthalmologist at a distance may acquire a 
working knowledge of the method, by study and 
practice in his own office. 

For three reasons Retinoscopy, in preference to 
Skiascopy, has been chosen as the title : 

First, that it may not be confounded with Skia- 
graphy. 



xii PREFACE TO THE FIRST EDITION. 

Second, that it is the name by which the test is 
universally known ; and — 

Third, that it is the retina in its relative position 
to the dioptric media which we study. 

120 S. Eighteenth St., Philadelphia, Pa., 
March, i8g-j. 



CONTENTS 



CHAPTER I. 

PAGE 

Definition. — Names. — Principle and Value of Retinoscopy. — 

Suggestions to the Beginner 9-13 

CHAPTER II. 
Retinoscope. — Light. — Light-screen. — Dark Room. — Source of 

Light and Position of Mirror.— Observer and Patient, . 14-19 

CHAPTER III. 
Distance of Surgeon from Patient. — Arrangement of Patient, 
Light, and Observer. — Reflection from Mirror. — How 
to Use the Mirror. — What the Observer Sees. — Retinal 
Illumination. — Shadow.— Where to Look and What to 
Look For, 20-27 

CHAPTER IV. 
Point of Reversal. — To Find the Point of Reversal. — What 
to Avoid. — Direction of Movement of Retinal Illumina- 
tion. — Rate of Movement and Form of Illumination. — 
Rules for Lenses. — Movement of Mirror and Apparatus, 28-38 

CHAPTER V. 
Retinoscopy in Emmetropia and the Various Forms of Regular 

Ametropia.— Axonometer, 39-55 

CHAPTER VI. 

Retinoscopy in the Various Forms of Irregular Ametropia. — 
Retinoscopy without a Cycloplegic. — The Concave Mir- 
ror. — Description of the Author's Schematic Eye and 
Light-screen. — Lenses for the Study of the Scissor Move- 
ment, Conic Cornea, and Spheric Aberration, 56-70 

INDEX, 71-72 



LIST OF ILLUSTRATIONS. 



FIG. PAGE 

1. Schematic Eye for Studying Retinoscopy 12 

2. Retinoscope, 15 

3. Light-screen, or Cover Chimney, «. . . . 16 

4. Showing Distance from Patient's Eyes in Inches and the Equivalent 

in Diopters, 21 

5. Arrangement of Patient, Light, and Observer, 22 

6. Folding Mirror 23 

7. Folding Mirror with Illumination, 23 

8. Illumination in an Emmetropic Eye, 27 

9. Illumination and Shadow in an Emmetropic Eye, 27 

10. Retinal Illumination with Straight Edge, 34 

11. Retinal Illumination with Crescent Edge, 34 

12. Wiedemann's Disc, 35 

13. Jenning's Skiascopic Disc, 36 

14. Gray Reflex as Seen in High Hyperopia, 39 

15. Gray Reflex, Crescent Edge, and Shadow in High Hyperopia, ... 39 

16. Hyperopia, 40 

17. Refracted Hyperopia, 41 

18. Emmetropia, 42 

19. Myopia, 44 

20. Refracted Myopia, 45 

21. Method of Writing a Formula, 48 

22. Band of Light in Astigmatism, 49 

23. Band of Light and Shadow, 49 

24. Band of Light, Axis 90 , 50 

25. Band of Light Showing Half a Diopter of Astigmatism, .... 51 

26. Axonometer 53 

27. Axonometer in Position, ■ 53 

28. 29. Irregular Lenticular Astigmatism, 57 

31. Two Bands of Light, . . 58 

30. Light Areas with Dark Interspace, 59 

32. Light Areas Brought Together, 59 

33. Illumination Seen in Conic Cornea, 62 

34. Positive Aberration, 63 

35. Negative Aberration, 63 

36. Lens for the Study of the Scissor Movement 68 

37. Lens for the Study of Conic Cornea, 68 

38. Lens for the Study of Spheric Aberration, 68 



RETINOSCOPY 



CHAPTER I. 

DEFINITION.- NAMES.-PRINCIPLE AND VALUE OF 

RETINOSCOPY. -SUGGESTIONS TO THE 

BEGINNER. 

Definition. — Retinoscopy may be defined as the 
method of estimating the refraction of an eye by 
reflecting into it rays of light from a plane or con- 
cave mirror, and observing the movement which 
the retinal illumination makes by rotating the mirror. 

Names. — Dioptroscopy, fundus-reflex test,*kera- 
toscopy, fantoscopy, pupilloscopy, retinophotoscopy, 
retinoskiascopy, skiascopy, umbrascopy, etc., are 
some of the other names given to this form of re- 
fraction, and- their number and greater or less inap- 
propriateness have had much to do, no doubt, with 
keeping retinoscopy in the background of ophthal- 
mology instead of giving it the prominence which it 
more justly deserved and now receives. 

The principle of retinoscopy is the finding of 
the point of reversal (the far-point of a myopic eye), 

* Suggested by Dr. C. A. Oliver. 
2 9 



io RETINOSCOPY. 

and to do this, if an eye is not already sufficiently 
myopic, it will be necessary to place in front of it 
such a lens, or series of lenses, as will bring the 
emergent rays of light to a focus at a certain definite 
distance (see Point of Reversal, chap. iv). 

Value of Retinoscopy. — Those who would 
criticize retinoscopy because " we see nothing and 
think nothing of the condition of the fundus," base 
their criticism apparently on the name, retinoscopy. 
rather than from any great amount of practical ex- 
perience with the method. While admitting that the 
ophthalmoscope in front of a well-trained eye can 
often make a close refractive estimate, yet only to 
the few does such skill obtain, and even then there 
is that uncertainty- which does not attach itself to the 
retinoscope in competent hands. The ophthalmolo- 
gist who knows how to use the mirror accurately 
has the advantage of his confreres who are ignorant 
of the test ; it gives him a position decidedly inde- 
pendent of his patient, and puts him above the 
common level of the traveling " Great Doctor Eye " 
and " refracting optician," who are tied to the trial- 
lenses and the patient's uncertain answers. Further- 
more, when it is remembered that from fifty to eighty 
per cent, of the patients consulting the ophthalmolo- 
gist do so for an error of refraction, it is well that 
he be most capable in this important part of the 
subject. 

The wonderful advantage of retinoscopy over 
other methods needs no argument to uphold it ; the 
rapidly increasing number of retinoscopists testify 
to its merits. 



VALUE OF RETINOSCOPY. n 

The writer, from the constant use of the mirror, 
would suggest the following axiom : That, with an 
eye otherwise normal except for its refractive error, 
and being under the influence of a reliable cycloplegic, 
there is no more accurate objective method of obtaining 
its exact correction than by retinoscopy. 

Retinoscopy gives the following advantages : 

The character of the refraction is quickly diag- 
nosed. 

The exact refraction is obtained without question- 
ing the patient. 

Little time is required to make the test. 

No expensive apparatus is necessarily required. 

Its great value can never be overestimated in 
nystagmus, young children, amblyopia, aphakia, illit- 
erates, and the feeble minded. 

From what has just been written, it must not be 
understood that the patient's glasses are ordered 
immediately, from the result obtained by retinos- 
copy ; for, on the contrary, all retinoscopic work, 
like ophthalmometry in general, should, when possi- 
ble, be confirmed at the trial-case. 

It is only in the feeble-minded, in young children, 
and in cases of amblyopia that glasses are ordered 
direct from the result obtained in the dark room. 

The subjective method of placing lenses before 
the patient's eyes and letting him decide by asking 
"is this better ? " or " is this worse ? " only too often 
fatigues the examiner and worries the patient, giving 
him or her a dread or fear of inaccuracy that does 
not satisfy the surgeon or tend to inspire the patient. 
Whereas, when the neutralizing lenses found by 



RETINOSCOPY. 



retinoscopy are placed before the patient's eyes and 
lie reads £ or fo- or more, it is easy, if there is any 
doubt, to hold up a plus and a minus quarter diopter 
glass respectively in front of this correction, and let 



Fig. 




Schematic Eye for Studying Retinoscopy. 
[For description, see chap, vi.) 



the patient tell at once if either glass improves or 
diminishes the vision. 

The writer is not condemning the subjective or 
other methods of refraction, or trying to extol too 
highly the shadow-test, yet he would remind those 
who try retinoscopy, fail, and then ridicule it, that 



SUGGESTIONS TO THE BEGINNER. 13 

the fault with them is back and not in front of the 
mirror. 

Suggestions to the Beginner. — To obtain profi- 
ciency in retinoscopy there is much to be understood. 
Careful attention to details must be given, and not a 
little patience possessed, as it is not a method that is 
acquired in a day, and it is only after weeks of con- 
stant application that accuracy is acquired. There- 
fore the beginner is strongly advised to learn the 
major points from one of the many schematic eyes 
in the market before attempting the human eye. At 
the same time he should be perfectly familiar with 
the laws of refraction and dioptrics, as an understand- 
ing of conjugate foci is really the underlying prin- 
ciple of the method ; i. e., a point on the retina being 
one focus and the myopic or artificially-made far- 
point the other focus. 

What is meant by major points applies more par- 
ticularly to the study of the retinal illumination, its 
direction and apparent rate of movement, also its 
form, the distance between the observer and the 
patient, how to handle the mirror, etc., all of which 
are referred to under their special headings. 



CHAPTER II. 

RETINOSCOPE.— LIGHT.-LIGHT-SCREEN.-DARK ROOM. 

SOURCE OF LIGHT AND POSITION OF MIRROR.— 

OBSERVER AND PATIENT. 

The Retinoscope, or Mirror. — Two forms of 
the plane mirror are in use — the one large, four centi- 
meters in diameter with a four- or five-millimeter 
sight-hole often cut through the glass ; and the other 
small, two centimeters in diameter, on a four-centi- 
meter metal disc, with sight-hole two millimeters in 
diameter, ;^/cut through the glass, the quicksilver or 
plating alone being removed. By thus leaving the 
glass at the sight-hole, additional reflecting surface 
is obtained at this point, which assists materially in 
exact work, as it diminishes the dark central shadow 
that shows so conspicuously at times, and particularly 
when the sight-hole is cut through the glass. The small 
mirror has an advantage over the large by reducing 
the area of reflected light, as only a one-centimeter 
area on each side of the sight-hole is of particular use. 
The small plane mirror * is the one recommended, 
and is made with either a straight or folding handle; 
the latter is for the purpose of protecting the mirror 
when carried in the pocket. The purpose of the 



* 'Philadelphia Polyclinic, November, 1893. Another form is 
described by Dr. E. Jackson, American Journal of Ophthal- 
mology, April, 1896. 

14 



THE LIGHT. 15 

metal disc on which the small mirror is secured is to 
keep the light out of the observer's eye, and enable 
him to rest the instrument against the brow and side 
of the nose, but if it's size should appear small, the 
observer can easily have a larger one made to suit 
his convenience. The plating or silvering on the 
mirror should be of the best, and free from any 
flaws or imperfections, for on its quality depends, in 
part, the good reflecting power of the mirror, which 
is very important. 




Fig. 2. — The Author's Retinoscope.* 

The central shadow just referred to as the result 
of the sight-hole had best be seen by the beginner, 
by reflecting the light from the mirror on to a white 
surface, before he begins any study, as this dark 
area may annoy him later if he does not understand 
its origin. 

The Light. — This should be steady, clear, and 
white. The Welsbach possesses all these qualities, 
but unfortunately its delicate mantle will not stand 

* See foot-note on preceding page. 



RETINOSCOPV. 



much jarring, and is easily broken in consequence, 
causing much loss of time and annoyance. The 
electric light with a twisted carbon and ground-glass 
covering with a round center of clear glass is grow- 
ing quite popular. For constant service, however, 
the Argand burner is decidedly the best, when the 
asbestos light-screen is used to intercept the heat. 
Whatever light is employed, it is 
well to have it on an extension 
bracket, so that the observer may 
move it toward or away from the 
patient, as necessary. 

The light-screen, or cover 
chimney, is made of one-eighth 
inch asbestos, and of sufficient 
size (six centimeters in diameter 
by twenty-one in height) to fit 
over the glass chimney of the 
Argand burner. 

Attached to the screen are two 
superimposed revolving discs that 
furnish four round openings, re- 
spectively five, ten, twenty, and 
thirty millimeters, any one of 
which may be turned into place 
as occasion may require. Care should be taken that 
the opening used is placed opposite to the brightest, 
and never opposite to the edge or the blue part of the 
flame. Formerly these screens were made of sheet- 
iron, but the asbestos has been found preferable, as 
it does not radiate the heat to the same extent as the 
iron. The purpose of the light-screen is to cover all 




Fig. 3. — The Author's 

LlOHT-S C R E E N, OR 

Cover Chimney. 
{For a further descrip- 
tion, see chap, vi.) 



DARK ROOM. 17 

of the flame except the portion which presents at 
the opening in the disc. 

Ten-millimeter Opening. — This will be used 
in most all retinoscopic work by the beginner. 

Five-millimeter Opening. — This is used to the 
best advantage and with no small amount of satis- 
faction by the expert when working close to the 
point of reversal. 

The room must be darkened, — and the darker the 
better, — all sources of light to be excluded except 
the one in use. It must not be supposed from this 
that the room must have its walls and ceiling 
blackened ; on the contrary, if the shades are drawn 
the room will be sufficiently dark, though of course 
a perfectly black room would be best, as giving a 
greater contrast to the condition to be studied. The 
exclusion of other lights, or beams of light, must be 
insisted upon, as the principal use of the darkened 
room is to keep all light except the light in use out 
of the eye to be examined, and also not to have 
other lights reflected from the mirror. 

As the method of using the concave mirror with 
source of light (twenty or thirty mm. opening in 
screen) beyond its principal focus (usually over and 
beyond the patient's head) has been superseded by 
the simpler and easier method of using the small plane 
mirror with source of light (one-half or one cm. open- 
ing in light-screen) brought as close to the mirror as 
possible, the description of retinoscopy which follows 
will refer to the latter. 

The Source of Light and Position of the 
Mirror. — The rays of light coming out of the round 



i8 RETINOSCOPY. 

opening in the light-screen should be five or six 
inches to the left and front of the observer, so that 
they may pass in front of the left eye and fall upon 
the mirror held before the right, thus leaving the ob- 
server's left eye in comparative darkness ; or the 
observer may use the mirror before the left eye in 
case he is left-handed and has the light to his right. 
It is always best for the observer to keep both eyes 
wide open and to avoid having any light fall into 
the unused eye, which would cause him much annoy- 
ance. Some observers hold the mirror before the 
eye next to the screen, but this is not recommended, 
for the reasons just mentioned. 

The observer need not make any note of his ac- 
commodation, as in using the ophthalmoscope, but, 
as he requires very acute vision, he should wear any 
necessary correcting glasses. Any observer whose 
vision does not approximate f will not get much satis- 
faction from retinoscopy. 

He should take his seat facing the patient, and, as 
the strength of the reflected light rapidly weakens as 
the distance between the mirror and the light-screen 
is increased, he should have the light-screen close to 
his face (not less than six inches) if he wishes to get 
the fullest possible strength of light on the mirror ; 
and when working to find the point of reversal, more 
exact work will be accomplished if this distance be- 
tween light and mirror is very short. The further 
the light from the mirror, the less brilliant its reflec- 
tion, and there will appear, under certain conditions, 
a conspicuous central shadow as the result of the 
sight-hole in the mirror — two very serious objections. 



THE SOURCE OF LIGHT AND POSITION OF MIRROR. 19 

The patient must have his accommodation thor- 
oughly relaxed with a reliable cycloplegic, and should 
be seated comfortably, one meter distant, in front 
of the observer, with his vision steadily fixed on the 
observer's forehead, just above the mirror. Or, what 
is even better, the patient may concentrate his vision 
on the edge of the metal disc of the mirror, but 
never directly into the mirror, as that would soon 
irritate and compel him to close his eye. 

In this way the patient avoids the strain of look- 
ing into the bright reflected light, and at the same 
time the macular region is refracted. It is custom- 
ary to cover the patient's other eye while its fellow 
is being refracted ; for obvious reasons this is spe- 
cially important in cases of "squint." To get the 
patient's eye and the observer's forehead just one 
meter apart, the distance may be marked off on the 
wall of the dark room on the side where the light is 
secured (see Fig. 5), or a meter stick for the purpose 
may be held in the hand of the observer or his 
assistant. 



CHAPTER III. 

DISTANCE OF SURGEON FROM PATIENT.— ARRANGE- 
MENT OF PATIENT, LIGHT, AND OBSERVER.— RE- 
FLECTION FROM MIRROR. -HOW TO USE THE 
MIRROR.— WHAT THE OBSERVER SEES.-RETINAL 
ILLUMINATION.— SHADOW.-WHERE TO LOOK AND 
WHAT TO LOOK FOR. 

Distance of Surgeon from Patient. — There is 
no fixed rule for this, and each surgeon may select 
his own distance. It might be well for the beginner 
to try different distances and then choose for himself. 
The writer prefers a one meter distance, and with 
few exceptions adheres to it. Some prefer six 
meters, others two meters, etc. The distance of one 
meter has important advantages : There is no get- 
ting up or down to place lenses in front of the 
patient's eye, as the patient or surgeon, or both, may 
lean forward for this purpose, if necessary. Another 
advantage is that at one meter distance there is a 
uniform allowance of one diopter in the estimate, 
which will be explained more fully under Rules for 
Retinoscopy at One Meter. 

The method of obtaining the point of reversal 
at points other than the regulation one meter re- 
quires such an amount of extra measuring and 
computing that it does not meet with the general 
favor and satisfaction accorded . to that found by 
producing an artificial myopia of one diopter. This 



ARRANGEMENT OF PATIENT, LIGHT, AND OBSERVER. 



can best be explained by refer- 
ence to figure 4, where if the ob- 
server is at one diopter, and the 
neutralizing lenses in front of the 
patient's eye focus the emergent 
rays at about that distance, he 
may have the liberty of moving 
forward five inches or backward 
five inches (a play of ten inches) 
in looking for the point of re- 
versal, and not make a possible 
error in his result of more than 
twelve one-hundredths (0.12) of 
a diopter ; whereas if he were 
working closer than this, he would 
likely make an error of 0.5 D., or 
even more, if he were not ex- 
tremely careful in measuring the 
distance at which he found the 
reversal point. 

Arrangement of Patient, 
Light, and Observer. — This 
has already been described in 
great part, but reference to the 
accompanying sketch may give 
the student a more exact appre- 
ciation of the arrangement than 
any lengthy description could do. 

For convenience of the begin- 
ner in using- the mirror, it is best, 
as here shown, to keep the sur- 
geon's eye, the light, and the 







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2 7S 
3.D 


>5 


3.50D 







875 








7 


5.50 D 


6 „!l"tL 









22 RETINOSCOPY. 

patient's eye on a horizontal line, and to accomplish 
this in children they will either have to stand, sit on 
a high stool, or on the parent's lap. The beginner 
will find it sufficiently difficult at first to keep the 
light on the patient's eye with the mirror held per- 
pendicularly, without inclining it up or down, as he 
would have to do if the arrangement suggested is 
not carried out. 




Fig. 5. — Arrangement of Patient, Light, and Observer. 



Reflection from the Mirror. — The rays of light 
coming from the round opening in the screen to the 
plane mirror are reflected divergently, as if they 
came from the opening in the screen situated just 
as far back in the mirror as they originally started 
from in front (see Figs. 16, 18, and 19), and the 
patient looking into the mirror sees a round, bright 



HOW TO USE THE MIRROR. 23 

spot of light, just as large as the opening in the 
screen. 

The nearer the light and mirror are brought to- 
gether, the brighter will be the reflected rays, and 
the more nearly will the observer's eye and source 
of light correspond. 




Fig. 6. Fig. 7. 

Author's Mirror with Folding Handle. 
Fig. 6. — Showing central light C, on small mirror B. This is the light the 
patient sees when looking into the mirror, and corresponds in size to the 
one-centimeter opening in screen. D is the folding cap handle to pro- 
tect B when not in use. A is the metal disc. 
Fig. 7.— Shows the light moved to one side as a result of tilting the mirror. 



How to Use the Mirror. — It should be held 
firmly before the right eye so that the sight-hole is 
opposite to the observer's pupil ; and that it may be 
steady, the second phalanx of the thumb should rest 
on the cheek just below the eye, the edge of the 



24 RETINOSCOPY. 

metal disc even touching the side of the nose if the 
observer's interpupillary distance is not too great. 
Thus held in position, its movements should be very 
limited, though they may be slow or quick, but never, 
at any time, should it be tilted more than one, two, or 
even three millimeters ; for if inclined more than this, 
the light is lost from the patient's eye. If the light, 
the patient's, and the observer's eyes are on a 
horizontal line, then to find the patient's eye with the 
reflected light all the observer has to do is to reflect 
the light back into the light-screen, and by rotating 
the mirror to his right, carry the reflected light 
around on the same line until the patient's eye is 
reached. This may seem like a superabundance of 
instruction, but the finding of the patient's eye, which 
appears so easy, is an immense stumbling-block, at 
the beginning, to most students. Another way to 
find the eye is for the observer to hold his left hand 
up between his and the patient's eye and reflect the 
light on to it, and when this is done to drop his hand 
and let the light pass into the observed eye. Hav- 
ing succeeded in finding the patient's eye, the 
observer, if he is not very careful in his limited 
movements of the mirror and himself, will turn the 
light from the eye almost before he knows it, and 
so be compelled to start and find it again ; this 
causes much loss of time. A little practice on the 
schematic eye will assist the beginner wonderfully 
and grive him courage, for if he hastens to the human 
eye, and then has to stop every minute or so to try 
and get the light on the eye, he soon becomes 
discouraged and shows his want of experience to 
the patient. 



WHAT THE OBSERVER SEES. 25 

What the observer sees ; or the general ap- 
pearance of the reflection from the eye. — With the 
mirror held still before his eye, and close up to the 
bright light coming from the ten-millimeter opening 
in the light-screen, the observer will obtain a reflec- 
tion from the patient's eye which varies in different 
patients, and is subject to certain changes in the 
same patient as the refraction is altered by correct- 
ing lenses, or it may be changed by the turning of 
the patient's eye, or lengthening the distance be- 
tween the mirror and the light, or increasing or 
diminishing the strength of the light, or increasing 
the distance between the observer and the patient. 
The reflection from the eye of the albino or blond is 
much brighter than from the brunette or mulatto, in 
whom it is not so bright, even dim. This character 
of the reflex is controlled, of course, in great part 
by the amount of pigment in the eye ground ; how- 
ever, in most instances there is more or less of an 
orange-red color to the reflex, and this is especially 
so as the point of reversal is approached. Cases of 
high errors of refraction give a dull reflex (see Fig. 
14) as compared to low errors, where the reflex is 
usually very bright (see Fig. 8). Should the media 
be irregular or not perfectly clear, the reflex is altered 
accordingly ; this will be referred to under the head 
of Irregular Astigmatism. The observer will also 
notice on the cornea and lens bright pin-point 
catoptric images, and at the inner edge of the iris, 
in many eyes, a very bright ring of light (see Fig. 8) 
about one millimeter in width, which is due to the 
very strong peripheral refraction ; and as the eye is 

3 



26 RETIXOSCOPY. 

being refracted and the point of reversal approached, 
this peripheral ring may develop into a broader ring 
of aberration rays, which at times will be annoying. 
This will be referred to under Spheric Aberration, 
chapter vi. 

Retinal Illumination. — By holding a strong con- 
vex lens closer to or further from a plane surface 
than its principal focus, or at the distance of its 
principal focus, and letting the sun's rays pass 
through it, there will be seen on the plane surface 
a round area of light ; it is this light area which cor- 
responds to the illumination on the retina, seen in 
retinoscopy by reflecting the light from the mirror 
into the patient's eye, and hence it is spoken of as 
the retinal illumination, the "illuminated area," "the 
area of light," "the image," etc. 

Of course, the form of this illumination is con- 
trolled, in great part, by the refraction of the 
patient's eye. 

Shadow. — This is the non-illuminated portion of 
the retina immediately surrounding the illumination. 
The illumination and shadow are, therefore, in con- 
tact, and the contrast is most marked and easily 
recognized when the illumination is brightest. It is 
by this combination of the illumination and non- 
illumination (shadow) that we study and give the 
" shadow-test " its name. In the dark room, the 
patient keeping his eye fixed, the retina is stationary 
and in total darkness, except the portion illuminated 
by the light from the mirror (see Fig. 8). If the 
mirror be rotated, the retinal illumination changes 
its place (see Fig. 9) and darkness, or shadow, 



WHERE TO LOOK AND WHAT TO LOOK FOR. 27 

appears in its stead. It is by this change of illumina- 
tion and shadow (darkness) that we often speak of a 
movement of the shadow. 

Where to Look and What to Look For. — 
With the patient, the- observer, and the source of 
light in position as directed, the rays of light are 
reflected into the eye from the mirror as it is gently 
rotated in the various meridians, and the (i) form, 
(2) direction, and (3) rate of movement of the retinal 
illumination are carefully noted through a four- or 
five-millimeter area at the apex of the cornea, as this 





Fig. 8. Fig. 9. 

Fig. 8. — Uniform Illumination in an Emmetropic Eye with Slight 

Spheric Aberration. 
Fig. 9. — Same Illumination as in Fig. 8, passed to the Left by 

rotating the Mirror, Darkness or Shadow following. 



is the part of the refractive media in the normal eye 
that the patient will use when the effects of the 
cycloplegic pass away and the pupil regains its 
normal size. 

The one- or two-millimeter area at the edge of the 
pupil should be avoided by the beginner, except in 
special instances, as only too frequently it contains 
a bright ring of light which may or may not give a 
stronger refraction than the area at the apex of the 
cornea (see Spheric Aberration, chap. vi). 



CHAPTER IV. 

POINT OF REVERSAL.-TO FIND THE POINT OF REVER- 
SAL.-WHAT TO AVOID.-DIRECTION OF MOVEMENT 
OF RETINAL ILLUMINATION.— RATE OF MOVEMENT 
AND FORM OF ILLUMINATION.- RULES FOR LENSES. 
-MOVEMENT OF MIRROR AND APPARATUS. 

Point of Reversal. — This maybe stated in several 
ways, namely: It is the far-point of a myopic eye, or 
The artificial focal point of the emergent rays of light 

(Fig. 17), or 
The point where the emergent rays cease to con- 
verge and commence to diverge, or 
The point conjugate to a point on the retina (Fig. 

20), or 
The point where the erect image ceases and the in- 
verted image begins, or 
The point distant from the eye under examination, 
where the retinal illumination can not be seen to 
move. 

To Find the Point of Reversal. — The recogni- 
tion of the point of reversal is the principle of retinos- 
copy. It is what is sought for, and, when obtained 
under certain definite arrangements, is the correct 
solution of the test. During the test it is easy to tell 
when the illumination moves with or against the light 
on the face, but to get the exact point where there 
is no apparent movement is not always easy, and is 
only acquired after careful practice. 



TO FIND THE POINT OF REVERSAL. 29 

For example, having determined at one meter that 
the retinal illumination with a -f 1.50 D. in front of 
the observed eye just moves with the light on the 
face, and against with a + 1.75 D., we know that the 
reversal point must be between the strength of the 
two lenses, or -\- 1.62 D. This demonstrates how we 
arrive at the exact correction, and also the capability 
and accuracy of retinoscopy. 

Emmetropic and hyperopic eyes, in a state of 
rest, emit parallel and divergent rays, respectively, 
and to give such eyes a point of reversal, or a focus 
for the emergent rays, it will be necessary to inter- 
cept these rays with a convex lens as they leave 
the eye. In other words, emmetropic and hyperopic 
eyes must be made (artificially) myopic. In myopic 
eyes, however, the emergent rays always focus at 
some point inside of infinity, and the observer may, 
therefore, if he is so disposed, by moving his light 
and mirror to or from the patient's eye, as the case 
may be, find a point where the retinal illumination 
ceases to move. If this should be at two meters, the 
patient would have a myopia of 0.50 D. ; if at four 
meters, a myopia of 0.25 D. ; if at one meter, a 
myopia of one diopter, etc. 

It is well for the beginner to remember, when using 
the plane mirror, that the illumination on the patient's 
face always moves in the same direction the mirror 
is tilted, but not necessarily so in the pupillary area, 
where it may move opposite ; and here it is that we 
speak of the retinal illumination moving with or 
against (opposite to) the movement of the mirror, as 
the case may be, and make our diagnosis accordingly. 



30 RETINOSCOPY. 

As the rays of light from the mirror proceed di- 
vergently to the patient's eye, as if they came from a 
point back in the mirror equal to the distance of the 
light (opening in light screen) in front of it and 
working at one meter's distance, with source of light 
five inches in front of the mirror, the rays appear to 
emerge from a point five inches back of the mirror, 
or a total distance of 45 inches from the patient's eye, 
thus giving the rays of light a divergence equal to 
0.87 of a diopter before they reach the patient's eye, 
and this point may be made conjugate to the retina. 
The observer will do good work if he reduces the 
retinal illumination to the utmost limit where it can 
be faintly seen moving with the movement of the 
mirror, and if this is done the observer's eye and 
mirror will be just inside of the point of reversal 
where the erect image can still be recognized. In 
doing this, however, he must allow 0.87 in his esti- 
mate and not 1.0 D. 

At the point of reversal no definite movement of 
the retinal illumination is made out and the pupillary 
area is seen to be uniformly illuminated, but not so 
brilliantly as when within or beyond the point of 
reversal. 

If the observer's eye is, at this point, exactly con- 
jugate to the retina, then the movement of the re- 
flected light on the retina can not be perceived 
(though it does move), and the retinal illumination 
will occupy the entire pupil and the shadow will be 
absent. 

Instead, however, of reducing the retinal illumina- 
tion to the utmost limit (as just mentioned), where 



WHAT TO AVOID. 31 

it can be faintly seen moving with the movement of 
the mirror, the writer prefers and recommends plac- 
ing before the eye under examination such a lens or 
series of lenses as will bring the emergent rays of 
light to a focus on his own retina, so that no move- 
ment of the retinal illumination can be recognized. 

When the point of reversal is approached, the 
uniform color of the retinal illumination occupies so 
much of the pupillary area that the student may 
think he has reached the point of reversal, and if he 
is not careful to pass the retinal illumination slowly 
across the pupil and get the shadow, he will find his 
result deficient, and possibly miss seeing some small 
amount of astigmatism. 

To make sure about the point of reversal, it is al- 
ways best, especially for the beginner, to keep put- 
ting on stronger neutralizing lenses until he gets a 
reversal of movement, when he knows at once that 
the point of focus of the emergent rays has passed 
in between the mirror and eye under examination. 

The lenses which control the rays of light emerg- 
ing from the patient's eye are spoken of as neutral- 
izing lenses. 

What to Avoid. — It occasionally happens that a 
retinal vessel or vessels or a remnant of a hyaloid 
artery, if present, or even the nerve head, may be 
seen when the light is reflected into the eye ; if so, 
they are to be ignored, as they are not parts of the 
test. If the patient's eye is turned, or the rays from 
the mirror fall obliquely, or the neutralizing lens in 
front of the eye is inclined instead of being perpen- 
dicular, there will be seen reflections of light and 



32 RETINOSCOPY. 

images upon the neutralizing lens or cornea, or both, 
and, in consequence, the retinal illumination is more 
or less hidden or obscured ; these images and reflec- 
tions can be easily corrected by removing the cause. 
The catoptric images can not be removed, but as 
they are very small the beginner soon learns to 
ignore them. The retinal illumination may occasion- 
ally contain a small dark center, which will disturb 
the beginner unless he remembers that it is caused 
by the sight-hole in the mirror, and that it shows 
particularly when the sight-hole is large and cut 
through the mirror. This same dark center in the 
illumination is also seen at times when the light is 
removed some distance from the mirror, and the cor- 
recting lens almost neutralizes the refraction. The 
neutralizing lens should never be so close to the eye 
that the lashes touch, and, in warm weather especi- 
ally, moisture from the patient's face may condense 
on the trial-lens, and temporarily, until it is removed, 
obscure the reflex. 

Retinoscopy with a Plane Mirror at One 
Meter's Distance and Source of Light close to 
the Mirror. — Direction of Movement of Retinal 
Illumination. — Rate of Movement and Form 
of Illumination. — These important points in refer- 
ence to the retinal illumination should be decided 
promptly and without any prolonged examination. 
This proficiency, of course, will only come by prac- 
tice, and if, on first examination, the observer can 
not decide whether the retinal illumination is with or 
opposite to the movement of the reflected light on 
the face, he may approach the eye until this point is 



FORM OF ILLUMINATION. 33 

determined. The three important essentials may 
be stated in the following order and in the form of 
rules : 

Direction. — The recognition of the direction that 
the retinal illumination takes when tilting the mirror 
is a most important point in the study of retinoscopy. 

The movement of the retinal illumination, when 
rotating the mirror, going with the movement of the 
light on the patient's face, signifies emmetropia, 
hyperopia, or myopia, if the myopia be less than one 
diopter. 

The apparent movement of the retinal illumina- 
tion going opposite to the movement of the light on 
the face always signifies myopia of more than one 
diopter. 

Rate of Movement. — This, of course, is under 
the control and is influenced in great part by the 
rate of movement of the mirror itself; yet after a 
little practice the observer will recognize the fact 
that there is a certain slowness in the apparent rate 
of movement of the illumination when the refractive 
error is a high one and requires a strong lens for its 
neutralization, whereas when the retinal illumination 
appears to move fast, the refractive error is but 
slight, and requires a weak lens for its correction. 

Form of Illumination. — A large, round illum- 
ination, while it may signify hyperopia or myopia 
alone, yet it does not preclude astigmatism in com- 
bination. 

When the illumination appears to move faster in 
one meridian than the meridian at right angles to it, 
astigmatism will be in the meridian of slow move- 
4 



34 RETINOSCOPY. 

ment. If the retinal illumination is a band of light 
extending- across the pupil it signifies astigmatism. 

The width of the band of light does not indicate 
so much the strength of the correcting cylinder 
required for its neutralization as does the apparent 
rate of movement; if slow, a strong, if fast, a weak, 
cylinder is required. 

The band of light that is seen when a spheric lens 
corrects one meridian, and the meridian at right 
angles remains partly corrected, indicates the axis of 
the cylinder in the prescription. 

f 3 

Fig. io.— Straight Edge, Indicat- Fig. ii.— Crescent Edge, Indi- 
ing Astigmatism. cating Spheric Correction. 



Rules for Placing Neutralizing Lenses. — A 
plus lens is required when the retinal illumination 
moves with the illumination on the face, and a minus 
lens is required when it moves opposite to the light 
on the face. 

Movement of the Mirror. — There are times 
when a quick movement, and, at other times, a slow 
or gradual movement, is required. A substitution of 
the quick for the slow movement, and the result can 
not always be correct. 

A quick movement may be used when looking 
into the eye before any correcting lens has been 



MOVEMENT OF THE MIRROR. 



35 






placed zVz «'/«. It often tells the character of the 
refraction. 

The slow movement comes into use and is of 
the utmost importance when the eye has been cor- 
rected to within 0.75 D. or less, as it is generally at 
this point that so many, by a quick 
movement, hasten the peripheral rays 
and mask the central illumination, giv- 
ing the idea at once of over-correc- 
tion (see Spheric Aberration, chap. 
vi). This is a most common error 
with the beginner, the inexperienced, 
and with those who fail to get good 
results and who ridicule retinoscopy 
as " not exact," or as " not agreeing 
with the subjective method." It is 
well in every instance, when the point 
of reversal is approached, to pass 
the retinal illumination (not the light 
area on the face) well across the 
pupillary area to make sure in regard 
to the character of shadow which fol- 
lows or precedes it. This movement, 
at such a point in neutralization, will 
often give a hint as to the presence 
of astigmatism or not, as a reference 
to drawings figures 10 and 11, will 
show. The presence of astigmatism is known by 
the straight edge of the illumination, or, in its place, 
a crescent edge would mean a spheric correction. 

Apparatus for placing lenses in front of the 
patient's eye. — There are several different forms in 



Fig 12. — Wiede- 
mann's Disc. 



36 RETINOSCOPY. 

the market, their purpose being twofold — to save 
time and any extra movements on the part of the 
surgeon. Of these, that of Wiirdemann {American 
Journal of Ophthalmology, p. 223, 1891) seems the 
best hand skiascope. A reference to the sketch 
shows this instrument with its convenient handle, 




Jesxing's Skiascopic Disc. 



whereby the patient, being instructed, raises or 
lowers the disc in front of the eye. with its smooth 
broad edge resting against the side of his nose. 

One column contains plus and the other minus 
lenses, and, as it is reversible, these may be placed 
in front of the eye as the surgeon directs. 

The most modern and complete revolving skias- 



MOVEMENT OF THE MIRROR. 37 

copic disc is that of Jennings [American Journal of 
Ophthalmology, November, 1896), and may be best 
understood from his own description : " It consists 
of thirty-nine lenses, inclosed in an endless groove 
and propelled by a strong driving-wheel situated at 
the lower end of the frame. A small rod runs the 
length of the table, and is connected at one end with 
the driving-wheel and at the other with a small wheel 
within reach of the operator's hand. At the sur- 
geon's end of the table, and facing him, is a disc on 
which, at a certain aperture, — marked L or R, ac- 
cording to which eye is under examination, — is in- 
dicated the lens presented at the sight-hole. The 
red numbers represent convex, and the white con- 
cave, lenses. The lenses range from 0.25 to 9 D. 
plus and from 0.25 to 10 D. minus. In addition to 
the lenses just mentioned are eight others, 0.25, 0.50, 
10 and 20 D. plus and minus, set in a separate disc, 
any one of which can be put in front of the sight- 
hole without rotating the whole series of convex or 
concave lenses. By means of this extra disc we 
can make combinations from 0.25 to 29 D. plus, and 
from 0.25 to 30 D. minus. In front of each sight- 
hole is placed a cell, marked in degrees, to hold 
cylinders (not shown in drawing). Attached to the 
back of the upright frame, by means of a hinge, is 
a chin-rest and a movable blinder, both of which 
swing to the right or left as may be desired. The 
whole is mounted on a strong stand, which can be 
raised or lowered to suit the requirements of each 
patient. The essential advantages of this skiascope 
are as follows : 



38 RETINOSCOPV. 

" (i) It saves time and fatigue in changing lenses. 

" (2) It is under the control of the operator, and 
indicates the lens in front of the sight-hole without 
his getting up. 

" (3) The mechanism is simple and durable. 

" (4) There are no shafts, uprights, or indicators 
to obstruct the view of the operator. 

" (5) It is only under exceptional circumstances 
that it is necessary to use the disc containing the 
extra lenses. 

" (6) There is only one indicator and one wheel 
to turn." 

While either the hand or the revolving disc is re- 
commended, yet the writer is partial to an accurately 
fitting trial-frame, using the lenses from the trial- 
case, which should be conveniently at hand. The 
following suggestions in the selection and use of 
the trial-frame are offered : The temples should rest 
easily on the ears, the nose-piece (bridge) to have 
a sufficiently long post to permit the eye-pieces to fit 
high and accurately over any pair of eyes, especially 
those of children, and have the corneae occupy the 
center of each eye-piece. Correct results can not 
be expected or quickly obtained unless the neutral- 
izing lenses be placed with their centers correspond- 
ing to corneal centers, and at the same time per- 
pendicular to the front of the eye. 



CHAPTER V. 

RETINOSCOPY IN EMMETROPIA AND THE VARIOUS 
FORMS OF REGULAR AMETROPIA.— AXONOMETER. 

Hyperopia. — By rotating the mirror in the vari- 
ous meridians and making a note of the direction 
and rate of movement of the retinal illumination, 
which in this form of refraction is with the move- 
ment of the light on the patient's forehead, a strong 





Fig. 14. Fig. 15. 

Fig. 14. — Gray Reflex as Seen in High Hyperopia, Even Darker 

than the Picture Shows it. 
Fig. 15. — Gray Reflex, with Crescent Edge by Tilting Mirror to 

Left, Darkness or Shadow Following. 

or weak plus sphere, according to the apparent rate 
of movement, is placed before the eye, and the 
rate of movement of the retinal illumination is again 
noted ; practice alone will guide the observer in a 
quick appreciation of the approximate strength of 
neutralizing lens to thus employ. 

If the movement of the illumination appears slow, 

and the observer places a -f 2.75 D. before the eye 

for its neutralization, and the illumination then 

becomes brilliant and appears to move fast and 

39 



40 RETINOSCOPV. 

with the light on the face, the hyperopia is still 
slightly uncorrected and a stronger lens must be 
substituted. (At this point in the examination the 
five-millimeter opening in the light-screen may be 
used to advantage.) 

Removing the + 2.75 D., and placing a -f 3.25 D. 
in its place, if the retinal illumination is found to 
move opposite to the movement of the light on the 
face, the refraction of the eye will then be between 
the + 2.75 D. and the 3.25 D., which is 3 D. (See 
example, p. 29, chap, iv.) Now, while the 13 D. 
has brought the emergent rays to a focus at one 




meter, it has made the eye myopic just one diopter, 
so that in taking the patient from the dark room to 
test his vision at six meters, or infinity, this one 
diopter (artificial myopia) must be subtracted from 
the -f- 3 D., which would leave + 2 D., the amount 
of the hyperopia. 

A reference to figures 16 and 17 will illustrate the 
description just given. 

Figure 16 is the hyperopic eye under examina- 
tion, and shows the mirror at one meter's distance, 
with the light five inches from the mirror. The dot- 
ted lines represent the rays proceeding divergently 



HYPEROPIA. 41 

from the eye under examination ; the dark lines show 
the reflected rays from the mirror, which illuminate 
the retina and have an imaginary focus (dotted 
lines) beyond the retina. 

Figure 17 is a profile view showing the hyperopic 
eye with neutralizing lens in position. The dotted 
lines with arrow-heads indicate the direction the rays 
would naturally take coming from the eye. The 
lens (+ 3 D.) in front of the eye is just sufficiently 
strong to bend these divergent rays and bring them 
to a focus at one meter's distance (artificial point of 




reversal). In other words, +2 D. of the three 
diopters thus placed before this hyperopic eye 
would have bent the divergent rays and made them 
parallel, or emmetropic, but the additional one 
diopter bends the rays still more and brings them 
to a focus (P. R.) at one meter. If now the ob- 
server approaches the eye thus refracted and ob- 
serves the retinal illumination closer than one meter, 
he will be inside of the point of reversal, and conse- 
quently see an erect image moving rapidly with the 
direction of the movement of the mirror. If beyond 
this point of reversal, he would get an inverted 



42 RETINOSCOPV. 

image and the retinal illumination moving rapidly in 
a direction opposite to the movement of the mirror. 

Emmetropia. — The emergent rays from an em- 
metropic eye are always parallel, and the observer 
seated at one meter sees the pupillary area in such 
an eye brilliantly illuminated, the illumination mov- 
ing rapidly with the light on the face as the mirror 
is slowly rotated. 

A reference to figure iS shows the emmetropic 
eye under examination with the position of light, 
mirror, and eye, as in figure 16. The dotted lines 




indicate the parallel emergent rays, and the solid 
lines the divergent rays from the mirror with an 
imaginary focus just beyond the retina. The pur- 
pose in this instance, as in all others of retinoscopy, 
is to place such a neutralizing lens before the eye 
as will bend the emergent rays and bring them to a 
focus at a certain definite distance, making the 
emergent rays from a point on the retina come to 
a focus on the observer's retina. Therefore, to 
change this illumination so that no movement can 
be seen to take place in the pupillary" area, and at 
the same time have the emergent rays focus on the 



MYOPIA. 43 

observer's retina, a -f i sphere must be placed 
before the eye. 

Myopia. — In myopia the emergent rays always 
converge to the far-point (point of reversal), and the 
observer, seated at one meter from the eye, will have 
the apparent movement of the retinal illumination 
going opposite to the light on the face if the myopia 
exceeds one diopter, and with the light on the face if 
the myopia is less than one diopter. If the myopia 
should be just one diopter, then the emergent rays 
would focus on the observer's retina at one meter, 
and there will not be any neutralizing lens required 
to accomplish this purpose ; but if the emergent rays 
focus beyond one meter, the observer will be within 
this point of reversal or focus, and will, therefore, 
have an erect image, moving fast with the move- 
ment of the mirror, and will have to place before 
the eye a plus lens of less than one diopter to 
bring the point of reversal up to one meter. When 
the myopia is more than one diopter, and observer 
at one meter, the emergent rays will have focused 
somewhere between the observer and the patient, 
and, as a result, the retinal illumination appears to 
move opposite to the light upon the face, more or less 
rapidly, according to the amount of myopia ; and a 
concave or minus lens must be placed in front of 
such an eye that will bring the emergent rays to a 
focus at one meter, or, in other words, will stop all 
apparent movement of the retinal illumination. If, 
for example, a — 2.75 D. has been so placed, and the 
movement is still slightly opposite to the movement 
of the mirror, and a — 3.25 D. substituted makes 



44 RETINOSCOPY. 

the retinal illumination move with the movement of 
the mirror, then the neutralizing lens for one meter 
would be the difference between — 2.75 D. and 
—3.25 D., which will be —3 D. 

Figure 19 shows the myopic eye just described, 
with the position of the mirror, light, and eye, as in 
figures 16 and 18. The solid lines represent the rays 
reflected divergently from the mirror focusing at a 
point in the vitreous before coming to the retina, and 
the broken lines show the rays emerging from a point 
on the retina and then converg-ine j- tne focus, far- 




r: ;-. 1: 

point or point of reversal close to the eye, between 
the eye and the mirror. The observer, seated with 
the mirror one meter distant gets an opposite move- 
ment in the pupillary area from the direction in which 
he moves his mirror, and. of course, an inverted 
image. If the observer had his eye at the point 
where the emergent rays focused (dotted lines cross), 
he would not recognize any movement in the pupil- 
lary area, and it would have a uniform reflex. The 
amount of the myopia is equal to the distance meas- 
ured from this point of reversal to the cornea: for 
example, if the distance (point of reversal) was 



twenty-five cm. from the patient's eye, then the 
amount of the myopia would be four diopters. 

Figure 20 is a profile view of the myopic eye. The 
dotted lines show the rays coming from a point on 
the retina and focusing at the far-point (f.p.); the 
solid lines show the emergent rays acted upon or 
bent by a plano-concave lens of three diopters, 
which has lessened the convergence of these emer- 
gent rays and put the far-point farther from the eye, 
or at a distance of one meter. The observer at 
this distance does not appreciate any movement in 



/ METER 



the pupillary area, but if he moves the light and 
mirror closer to the eye he is then inside the point 
of reversal and gets an erect image moving with the 
movement of the mirror; if beyond the one meter's 
distance, an inverted image and movement against 
the movement of the mirror will be seen. If a — 4 D. 
lens had been placed before this myopic eye, the 
emergent rays would have proceeded from it par- 
allel, and the observer, at one meter, would have the 
same conditions as in the refraction of an emme- 
tropic eye, figure 18 ; but as only a — 3 D. glass was 
used, the eye has one diopter of its myopia uncor- 



46 RETINOSCOPY. 

rected. From the description of retinoscopy in 
hyperopia, emmetropia, and myopia, just given, the 
student will recognize at once that the hyperopic, 
emmetropic, and myopic eye of less than one 
diopter, working with the plane mirror at one meter's 
distance, are given a stronger refraction than they 
naturally call for, or, in other words, are made, artifi- 
cially, myopic one diopter. And the myopic eye of 
more than one diopter, under similar conditions, 
being already myopic, retains one diopter of its 
myopia. To give a patient thus refracted with the 
retinoscope his emmetropic correction (correction for 
parallel rays of light), an allowance must always be 
made, in all meridians, of one diopter, no matter zuhat 
the refraction. The artificial myopia thus produced 
at one meter gives the following rules for glasses 
required for infinity: 

Rules. — i. When the neutralizing lens employed 
is plus, then subtract one diopter. 

2. When the neutralizing lens employed is minus, 
then add a — i D., or what is more simple, or even a 
better rule, is, To always add a — / sphere to the 
neutralizing lens obtained in the dark room when 
working at one meter, and the result will be the 
emmetropic or infinity correction. 

Examples : 

Dark Room, +0.50 0.00 -f-1.00 +2.00 — 1.00 

Adding, — 1 00 — 1.00 — 1.00 — 1.00 — 1.00 



Emmetropic Correction, — 0.50 — 1.00 — 0.00 -)-i.oo —2.00 

The main point in all retinoscopic work to remem- 
ber in changing from the dark room to the six vieter 



REGULAR ASTIGMATISM. 47 

correction, is to always allow for the distance from the 
patient's eye to the point of reversal ; i. e., if working 
at half a meter, allow two diopters ; if at two meters, 
0.50 D. ; if at four meters, 0.25 D., etc. 

Regular Astigmatism. — When refracting with 
the retinoscope, the observer should remember that 
he is refracting the meridian in the direction of which 
he moves the mirror. Particular attention is called 
to this important fact on account of the confusion 
sometimes arising in the student's mind from the 
use of the ophthalmoscope, where the refractive 
condition of a certain meridian is studied by the 
appearance of the vessels at right angles to it. 
Astigmatism being present in an eye, means a differ- 
ence in the strength of the glass required for the 
two principal meridians, which, with few exceptions, 
are at right angles to each other, and it is to these 
two principal meridians only that the observer pays 
attention ; for example, the eye that takes the follow- 
ing formula, 

-)- too D. Q -j-i.oo c. axis 105 , 

means that in the 105 meridian there is -f- 1 D. and 
in the 1 5 meridian a + 2 D. In the dark room a 
-f- 2 sphere in front of such an eye at one meter 
would correct the 105 meridian and partly correct 
the 1 5 meridian ; or a + 3 D. would correct the 1 5 
and over-correct (movement against) the 105 mer- 
idian. When with + 2 D. the 105 meridian is cor- 
rected and the 15 only partly so, there is seen in the 
15 meridian a band of light which stands or extends 
across the pupil in the 105 meridian and moves 



48 RETINOSCOPY. 

across the pupil from left to right with the move- 
ment of the mirror as it is tilted in the 15 meridian. 
The presence of this band of light after the mer- 
idian of least ametropia has been corrected always 
signifies astigmatism, and the axis it subtends — in 
this case 105 — gives the axis of the cylinder in the 
prescription ; and the amount of the astigmatism, or 
the strength of the cylinder required, is the differ- 
ence between the strength of the two spheres em- 
ployed. Figure 21 shows the method of writing 



+3.D 




such a dark room correction, and adding, according 
to our rule, a — 1 to this dark room work, we get 
our original formula : 

-f- 1. 00 D. Q -f -100 c - ax ' s IO S°- 
The method of correcting with spheres will be found 
much more satisfactory than by placing a + 2 D., 
as called for in the 105 meridian, then adding and 
changing cylinders until the correct one is found. 
It takes much time and care to get the cylinder axis 
just right, and is most difficult in the dark room. 
After the result has been obtained with spheres, the 



REGULAR ASTIGMATISM. 49 

observer may, if he is so disposed, prove it before 
leaving the dark room with the sphero-cylinder 
combination. 

Astigmatism may or may not be recognized on 
first inspection of the fundus-reflex, this depending 
entirely on the refraction ; if it be a high astigmatism 
with a small amount of refractive error in the op- 
posite meridian, as in one of the following formulas, 

-f- 1. 00 D ^ + 3-°° c - ax ' s 45°) 
— 1.00 D. 3 — 4.00 c. axis 180 , 

then the band of light so characteristic of astigma- 





Fig. 22. Fig. 23. 

Fig. 22. — Band of Light at Axis 60°, with the 60° Meridian Neu- 
tralized. No movement of the illumination can be recognized in this 
meridian. 

Fig. 23.— Shows the same as figure 22, but the band of light with straight edge 
has been moved upward and to the left by tilting the mirror in the 150 
meridian. 



tism will be plainly seen on first inspection, extend- 
ing across the pupil before any neutralizing lens has 
been placed in position ; but if the hyperopia or my- 
opia be high and the cylinder required is low, as in 
one of the following formulas, 

-f- 3 00 D. 3 -J- 0.75 c. axis 105°, 
— 4.00 D. Q — 1. 00 c. axis 165 , 
then the band of light is not recognized on first in- 
spection or until an approximate correction has 
5 



RETINOSCOPY. 



been placed before the eye. To get an idea of 
what the band of light looks like, the beginner may 
refer to figures 22 and 24; or focus rays of light 
through a strong cylinder; or place a cylinder in 
front of the schematic eye and study the retinal 
illumination. The student should bear in mind that 
the axis of the band of light appears on the mer- 
idian of least ametropia, and is brightest when this 
meridian has received its full spheric correction — 
the opposite meridian being only partly corrected. 

The reason for the brightness of the band of light 
when the meridian of its axis is corrected is that 
any point on the retina in this 
meridian is conjugate to the 
focus on the observer's retina 
(point of reversal), and any 
movement of the mirror in this 
meridian is not recognized, but 
has a uniform color and occu- 
pies the entire meridian of the 
pupil. To recognize so small 
an error as a quarter diopter cylinder, — which is 
not easily detected, and the observer, if he is in a 
hurry, might think the case one of simple hyperopia 
or myopia, — the writer would suggest that when 
the supposed point of reversal is reached the cor- 
recting sphere be increased a quarter of a diopter, 
and if only one meridian is found over-corrected 
(movement opposite), the other remaining correct 
(no movement recognized), he then knows that a 
quarter cylinder is required; for example, a + 2 D. 
is supposed to correct all meridians, and yet by 




Fig. 24. — Band of Light 
Astigmatism Axis 90 . 



MIXED ASTIGMATISM. 



substituting a -f 2.25 D. the vertical meridian moves 
against and the horizontal remains stationary ; then 
a -j- 0.25 D. cylinder is called for at axis 90 . 



o 



Fig. 25. — Band of Light Showing Half a Diopter of Astigmatism. 

Cases having a low astigmatic error of 0.50 D. 
can be recognized when near the point of reversal 
by the faint shaded area on each side of the band 
of light, as shown in figure 25 — a condition often 
overlooked. 

Mixed Astigmatism. — In this condition of re- 
fraction, where one meridian is myopic and the 
meridian at right angles to it is hyperopic, the move- 
ment of the retinal illumination in the myopic meri- 
dian will be controlled by the amount of the myopia. 
The illumination in the myopic meridian, if the my- 
opia is less than one diopter, moves with the mirror, 
and against the movement of the mirror if it is more 
than one diopter ; in either instance the observer 
gets a distinct band of light in the meridians alter- 
nately as each meridian is neutralized separately with 
a sphere. Taking the following example, 

— 2.00 c. axis 180 Q -|- 1. 00 c. axis 90 , 

the 90 meridian shows an opposite movement, and 
in the horizontal the movement is with the move- 
ment of the mirror. If, now, a — 1 D. sphere be 
placed before the eye, the 90 meridian is neutralized 



52 RETINOSCOPV. 

for one meter distance, and a bright band of light 
is seen at 90 , moving with the movement of the 
mirror on the horizontal meridian. Removing the 

— 1 D. and placing a -f 2 D. before the eye, which 
would neutralize the horizontal meridian for one 
meter, a bright band will be seen on the horizontal 
axis and moving opposite to the movement of the 
mirror in the 90 meridian. Carrying out the rule 
of always adding a — 1 D. sphere to the correction 
obtained in the dark room at one meter, we have 

— 1 added to the — 1 in the vertical meridian, 
making — 2 D., axis 180 ; and adding — 1 to the 
+ 2 D. in the horizontal, we have -|- 1 D. for axis 
90 , or our original formula : 

— 2. 00 axis 180 3 ~r I -°° c - ax ' s 9°°- 

The rule for neutralizing lenses in mixed astigma- 
tism is the same as for any other form of refraction ; 
namely, using a plus lens when the movement is 
with, and a minus lens when the movement is oppo- 
site to, the movement of the light on the face. 

Axonometer. — To find the exact axis subtended 
by the band of light while studying the retinal illumi- 
nation, when the meridian of least ametropia has 
been corrected, the writer has suggested a small in- 
strument which, for want of a better name, he has 
called an axonometer. 

Figure 26 shows this instrument, and figure 27 the 
axonometer in position. 

The description of this device was published in 
The Medical News, March 3, 1894, as follows: "The 
direction of the principal meridians of corneal curva- 



AXONOMETER. 53 



ture is often difficult to determine, and the state- 
ment of the patient must be accepted when confirm- 




ing the shadow-test correction ; or, if there is still 
uncertainty, the ophthalmometer of Javal must be 
brought into use. The axonometer is a black metal 




Fig. 27. 



disc, with a milled edge, one and one-half mm. in 
thickness, of the diameter of the ordinary trial-lens, 



54 RETINOSCOPY. 

and mounted in a cell of the trial-set. It has a 
central round opening 12 mm. in diameter — the dia- 
meter of the average cornea at its base. Two 
heavy white lines, one on each side, pass from the 
circumference across to the central opening, bisecting 
the disc. To use the axonometer, place it in the 
front opening of the trial-frame, and with the patient 
seated erect and frame accurately adjusted so that 
the cornea of the eye to be refracted occupies the 
central opening, proceed as in the usual method of 
making the shadow-test. As soon as that lens is 
found which corrects the meridian of least ametropia, 
and the band of light appears distinct, turn the 
axonometer slowly until the two heavy white lines 
accurately coincide, or appear to make one continu- 
ous line with the band of light (see Fig. 27). 

" The degree marks on the trial-frame to which 
the arrow-head at the end of the white lines then 
points is the exact axis for the cylinder. The axo- 
nometer possesses the following points of merit: 

" Simplicity. 

" Accuracy. 

" Small expense. 

"It covers an unnecessary part of the trial-lens 
which too frequently gives annoying reflexes and 
images. 

" It saves time, avoids the statement of the patient, 
and renders the ophthalmometer unnecessary. 

" Its color (black) absorbs the superfluous light 
rays from the mirror and gives a stronger contrast 
to the reflex and central illumination. 



AXONOMETER. 55 

" Limiting the field of vision in children, it permits 
of more concentrated attention. 

"For children and nervous patients, when it is 
difficult to use the ophthalmometer, this simple 
appliance is of great service." 



CHAPTER VI. 

RETINOSCOPY IN THE VARIOUS FORMS OF IRREGULAR 
AMETROPIA. - RETINOSCOPY WITHOUT A CYCLO- 
PLEGIC. — THE CONCAVE MIRROR. — DESCRIPTION 
OF THE AUTHOR'S SCHEMATIC EYE AND LIGHT- 
SCREEN.— LENSES FOR THE STUDY OF THE SCISSOR 
MOVEMENT, CONIC CORNEA, AND SPHERIC ABERRA- 
TION. 

Irregular Astigmatism. — This condition is 
either in the cornea or in the lens ; in any instance 
it is confusing to the beginner, and even the expert 
must work slowly to obtain a result. The corneal 
form is most difficult to refract, as the retinal illumi- 
nation is more or less obscured by areas of darkness. 
The illumination between these dark areas appears 
to move with, in places, and in others against, the 
movement of the mirror. By moving the mirror so 
as to make the light describe a circle around the 
pupillary edge, a most unique kinetoscopic picture is 
obtained, which is quite diagnostic of the condition. 
To refract an eye with this irregularity the observer 
may have to change his position several times, going 
closer to or farther away from the patient. Very 
often these eyes are astigmatic, and the band of light 
may be promptly noted by the observer changing 
his position as suggested, and at the same time plac- 
ing a neutralizing lens in position. Care mast be 
taken, also, to refract in the area of the cornea that 
will correspond to the small pupil when the effect of 
56 



IRREGULAR ASTIGMATISM. 57 

the cycloplegic passes away. It is often best, in 
these cases of irregular corneal astigmatism, to retain 
the correction found and use it to assist in a post- 
cycloplegic manifest refraction. 

Irregular astigmatism of the lens is frequently 
more or less uniform, and not so broken as in the 
corneal variety. Figures 28 and 29 show two kinds 
of irregular lenticular astigmatism. 

Figure 28 illustrates the spicules pointing in from 
the periphery, and as long as these do not encroach 
upon the pupillary area they do not usually in them- 
selves interfere with vision ; they are not often 





Fig. 28. Fig. 29. 

Irregular Lenticular Astigmatism. 

recognized until the pupil is dilated, are then very 
faint, and not usually made out until the point of 
reversal is approached. Figure 29 is another form 
of irregular lenticular astigmatism, and a very inter- 
esting picture as studied with the retinoscope ; and, 
as in figure 28, when very faint, is not made out 
until close to the point of reversal. These two 
forms of irregular lenticular astigmatism, when just 
beginning are very seldom seen with the ophthal- 
moscope ; the striations are too fine to be made out 
except under the conditions just described, and when 
recognized are of inestimable value from a point of 
prophylactic treatment, calling for a change of occu- 



58 



RETINOSCOPY. 



pation, rest to the eyes, and carefully selected glasses, 
the latter often being weak lenses. These lenticular 
conditions not infrequently accompany the "flannel- 
red" fundus, the "fluffy eye ground," the "shot-silk 
retina," the "woolly choroid," etc. 

Scissor Movement. — Another form of astig- 
matism that may be classed as irregular is where 
there are two areas of light, each with a straight edge, 
and usually seen on the horizontal meridian, or 
inclined a few degrees therefrom either way, and 
moving toward each other as the mirror is tilted in 




-Light Areas Coming Together and Dark Interspace 
Fading. 



the opposite meridian ; in other words, as the ob- 
server is seated at one meter he sees an area of 
light above and an area of light below with a dark 
interspace (Fig. 30). As the mirror is slowly tilted 
in the vertical meridian these light areas approach 
and are followed by darkness or shadow, and at the 
same time the dark interspace begins to fade, giving 
the picture as shown in figure 31. When the light 
areas are brought together, they result in a hori- 
zontal band of light, as seen in figure 32, and at this 
point resemble the ordinary band of light as seen in 
regular astigmatism. This movement of the light 



SCISSOR MOVEMENT. 59 

areas is likened to the opening and closing of the 
scissor blades, and hence the name of scissor move- 
ment. 

These cases are more or less difficult to refract, 
but the presence of the two areas of light with the 
dark interspace will often assist in a correct selec- 
tion of glasses, for while they are generally of the 
compound hyperopic variety, calling for a plus 
sphere and plus cylinder, yet practice and the patient's 



f^ C3 



Fig. 30. Fig. 32. 

Fig. 30. — Light Arka Above and Below, with Dark Interspace 
Fig. 32. — Light Areas Brought Together. 



statement often call for a plus sphere and minus 
cylinder. 

With the following formula, 

-f- 2.00 D. Q-f- 0.75 c. axis 90 , 

substituting a sphere the strength of the combined 
values of the sphere and cylinder, and using a minus 
cylinder of the same number as the plus cylinder 
at the opposite axis, the result will be, 

-+- 2.75 D. Q — 0.75 c. axis 180 . 

The vision with the latter formula is much better 
in many instances than with the former, and though 
either formula would be correct, yet the latter is 
practically the better of the two, and should be 



6o RET1NOSCOPY. 

ordered when so found. The condition which may 
be the probable cause of the scissor movement is a 
slight tilting of the lens ; that is, the antero-posterior 
axis of the lens does not stand perpendicular to the 
plane of the cornea, thus making one portion of the 
pupil myopic (area of light moving opposite) and the 
odier portion hyperopic (area of light moving with 
the movement of the mirror). This condition may 
be simulated by placing a convex lens at an angle 
before the schematic eye, or reflecting the light into 
the eye obliquely, or by using the combination lens 
in front of the schematic eye, as suggested on page 
6S. What causes the tilting of the lens, the writer 
is not prepared to state positively ; it may be con- 
genital, and yet careful inquiry of the patients, in 
many instances, has shown that it is most likely due 
to using the eyes to excess in the recumbent posture. 
It may be a coincidence, but most of the cases of 
scissor movement seen by the author have been in 
adults, and those who were in the habit of reading 
while lying down, reading themselves to sleep at 
night in bed.* Other cases were seen among 
paper-hangers, whose occupation compelled them to 
look upward much of the time. These do not seem 
unlikely causes, especially when the anatomy of the 
ciliary region is considered, the strain of the accom- 
modation (possibly spasm) during the faulty position 
of the eye tilting the lens as it rests upon the 

* The writer does not wish to be misunderstood and does not 
say that every one who uses his eyes in this faulty position must 
develop this form of irregular astigmatism. 



COMPOUND IRREGULAR ASTIGMATISM. 61 

vitreous body. This form of astigmatism, so far 
as known, remains a permanent one even after a 
cessation from the original cause and correcting 
glasses have been ordered. The retinoscope is the 
only instrument of precision we have in diagnosing 
this condition. The ophthalmoscope may recognize 
the presence of the astigmatism, but not its char- 
acter, and the ophthalmometer only records the 
corneal curvature. 

Compound Irregular Astigmatism. — This is 
a combination of the scissor movement and regular 
astigmatism, but they are not at right angles to each 
other. The scissor movement may be at 180 , and 
the regular astigmatism at some point away from 
90 , but not at 90 ; or the regular astigmatism may 
be at 90 and the scissor movement at some meri- 
dian other than 180 . 

A hasty review of the literature of astigmatism 
does not reveal any reference to this form, and the 
name for the condition has been suggested by the 
following picture, namely : When studying the reflex, 
a vertical band of light will be seen passing across 
the pupillary area from left to right as the mirror is 
turned, and then in the vertical meridian (not at 
right angles) the scissor movement will be recog- 
nized also ; there is, therefore, a combination of 
regular corneal astigmatism with the scissor move- 
ment at an oblique angle, giving the compound 
name suggested. This form of astigmatism is rare, 
yet not difficult to diagnose or refract when under- 
stood. It is hoped, however, that the beginner in 
retinoscopy may not meet one of these on his first 
attempt at the human eye. (See page 70.) 



62 RETINOSCOPY. 

Conic Cornea. — Reflecting the light into an eye 
that has such a condition, the observer is impressed 
at once with the bright central illumination that 
moves opposite to the movement of the mirror, the 
peripheral illumination moving with, unless perchance 
the margin should be myopic also, but of less degree. 
This form of illumination is seen in figure 33, showing 
the central illumination' faintly separated by a shaded 
area or ring from the peripheral circle. The best 
way to refract a case of this kind is to keep a record 
of the neutralizing lens or lenses required for the 
portion of the pupillary area that will correspond to 
the size of the pupil after the effect of the cycloplegic 




Fig. 33. — Illumination Seen in Conic Cornea 



passes away, and use this record as a guide in a 
post-cycloplegic manifest correction, as in irregular 
corneal astigmatism. 

As the apex. of the cone is not always central, the 
observer must not expect to always find the bright 
illumination in the center of the pupillary area, as 
just mentioned ; and it is also well to note the fact 
that a band of light will often appear during the 
process of neutralization, as astigmatism is usually 
present. This is further described on page 70. 

Spheric Aberration. — This appears under two 
forms, positive or negative, and is the condition in 
which during the process of neutralization there are 



SPHERIC ABERRATION. 



63 



two zones, one central and the other peripheral, 
where the refraction is not the same. In positive 
aberration the peripheral refraction is stronger and 
in negative aberration the peripheral is weaker than 
the central area ; that is to say, in the positive form, 
when the point of reversal for the center of the pupil 




Fig. 34. — Positive Aberration. 

is close to one meter, the peripheral illumination 
grows broader and has a tendency to, and often will, 
crowd in upon the small central illumination, giving 
the idea of neutralization, or even the appearance 
of over-correction, the illumination in the periphery 
moving opposite. The observer must be on his 




Fig. 35. — Negative Aberration. 



guard for this condition, and while giving the mirror 
a slow and limited rotation must watch carefully the 
illumination in the center of the pupil and not hasten 
the peripheral movement. (See What to Avoid, 
p. 26, chap, iv.) The observer may have to ap- 
proach the patient's eye closer than one meter if the 



64 RETINOSCOPY. 

peripheral illumination appears to move very fast. 
The negative form is where the peripheral refraction 
is weak as compared to the central, which appears 
strong, and when the neutralizing lens gives a point 
of reversal at the center of the pupil the peripheral 
illumination still moves with the movement of the 
mirror. This condition is seen in cases of conic 
cornea. 

Figure 34 illustrates positive aberration where the 
parallel rays passing through a convex lens in the 
periphery at A A come to a focus at A', much 
sooner than the parallel rays B B, near the center, 
which come to a focus back of A' at B'. 

Figure 35 illustrates negative aberration, which is 
the reverse of positive aberration, and the central 
rays B B are focused at B' in front of the peripheral 
rays A A focusing at A'. 

Retinoscopy Without a Cycloplegic. — Cases 
of myopia and mixed astigmatism which have 
large pupils can be quickly and accurately re- 
fracted by the shadow-test without the use of a 
cycloplegic. This has been repeatedly proven by 
comparison of the manifest and cycloplegic results ; 
yet it is not a method to be recommended or pur- 
sued, for two reasons : One is that these patients 
are not annoyed, like hyperopics, by the blurred near- 
vision incident to the cycloplegic ; and, secondly, 
glasses ordered without the cycloplegic seldom give 
the comfort that follows from the physiologic rest 
the eye receives from the drug. The surgeon will 
obtain much assistance and save time by using the 
retinoscope in cases of aphakia, in old people 



SCHEMATIC EYE FOR STUDYING RETINOSCOPY. 65 

especially who are very slow to answer, and will 
insist upon a description of what they do and do 
not see, as also in re-reading the test-card from the 
very top each time a change of lens is put in the 
trial-frame. Presbyopes of fifty or more years of 
age can be quickly and not inconveniently refracted 
by the shadow-test after having their pupils dilated 
with a weak (four per cent.) solution of cocain. 

Concave Mirror. — While the study of retinos- 
copy with the concave mirror is not a part of the sub- 
ject of this book, and allusion to it has been carefully 
avoided up to this time, yet for the benefit of those 
who may wish to try it, the writer would suggest 
that it will be necessary to place the source of light 
(20 or 30 mm. opening in light-screen) above and 
beyond the patient's head, one meter distant, or more, 
so that the convergent rays from the mirror come to 
a focus and cross before entering the observed eye. 
Then to estimate the refraction, proceed as with 
the plane mirror, remembering, however, that the 
movements of the retinal illumination are just the 
reverse of those obtained when using the plane 
mirror. 

The Author's Schematic Eye for Studying 
Retinoscopy. — For illustration see figure i and the 
Journal of the American Medical Association, Janu- 
uary 5, 1895. The eye as here shown, slightly reduced 
in size, is made of two brass cylinders, one somewhat 
smaller than its fellow, to permit slipping evenly into 
the other. Both cylinders are well blackened inside, 
and the larger is also blackened outside. The smaller 
cylinder is closed at one end (concave surface), and 



66 RETINOSCOPY. 

on its inner surface is placed a colored lithograph of 
the normal eye ground. The larger cylinder is also 
closed at one end, except for a central round opening 
10 mm. in diameter, which is occupied by a -f 16 D. 
lens, and on its outer surface is a colored lithograph 
of the normal eye and its appendages ; the pupil 
is left dilated, and corresponds to the central open- 
ing just referred to. In addition to the picture of 
the eye, there is also lithographed on the upper half 
of the periphery the degree marks similar to those 
on a trial-frame. To the lower half of the periph- 
ery are secured, at equal distances, three posts 
with grooves to hold trial-lenses. On the side of 
the small cylinder is an index which records emme- 
tropia, and the amount of myopia and hyperopia, as 
it is pushed into or drawn out of the large cylinder. 
The eye is mounted on a convenient stand and up- 
right, so that it may be moved as required. In using 
this eye, if the red eye ground and retinal vessels 
disturb the beginner then he may substitute a piece 
of white paper for the retina. To study astigmatism 
with the model, the beginner will have to place a 
cylinder, of known strength, in the groove next to 
the eye and study the characteristic band of light 
so diagnostic of this condition, and at the same time 
he should learn to locate the axis of the band with 
the axonometer. 

The author's light-screen or cover chimney 
(see figure 3 and the Annals of Ophthalmology and 
Otology, October, 1896) is made of one- eighth inch 
asbestos, and of sufficient size to fit easily over the 
glass chimney of the Argand burner ; attached to 



LIGHT-SCREEN OR COVER CHIMNEY. 67 

the asbestos by means of a metal clamp are two 
superimposed discs which revolve independently of 
each other. The lower disc contains a piece of white 
porcelain, 30 mm. in diameter ; also four round open- 
ings, respectively 5, 10, 20, and 35 mm. in diameter. 
The upper disc contains a round 35 mm. opening, a 
round section of blue cobalt glass, a perforated disc, 
a vertical and a horizontal slit, each 2^ by 25 mm. 
The several uses of this screen are as follows : 

1 . For the ophthalmoscope a good light is obtained 
by superimposing the two 35 mm. openings. 

2. Combining the 35 mm. opening in the upper 
with either the 5 or 10 mm. in the lower disc a 
source of light is produced for the small retinoscope ; 
and, 

3. By substituting the 20 mm. opening, light is had 
for the concave mirror. 

4. Placing the cobalt glass over the 5, 10, 20, or 
35 mm. opening, and the chromo-aberration test of 
ametropia is given. 

5. To test for astigmatism at one meter while 
using the plane mirror, or for heterophoria at six 
meters, the perforated disc is to be turned over the 
porcelain, the latter producing a clear white image. 

6. The horizontal slit placed over the porcelain 
glass, and the operator may exercise the oblique 
muscles. 

7. The vertical slit similarly placed gives the test 
for paralyzed muscles. 

Lenses for the Study of the Scissor Move- 
ment, Conic Cornea, and Spheric Aberra- 
tion. — -(Described by the author in the Journal 



RETINOSCOPY. 



of the American Medical Association, December 1 8, 
1897.) 

As the scissor movement, conic cornea, and spheric 
aberration, as recognized by the retinoscope, are so 
difficult of demonstration, except in the individual 
patient, the writer has suggested and had made three 
lenses which will illustrate these conditions respec- 
tively when placed in front of his schematic eye ; 
and thus the beginner in retinoscopy may have the 
opportunity to see, know, and study these important 
and interesting manifestations (and at small expense) 



P 



Fig. 36. 



Fig. 37. 



-ao) 



Fig. 38. 



before proceeding direct and in comparative igno- 
rance to his patient. 

Figure 36 is a plano-concave cylinder of two diop- 
ters, mounted in a cell of the trial-case, and to one- 
half of its plane surface is cemented (at the same 
axis) a plano-convex cylinder of four diopters, thus 
making a combination lens, one half of which is a 
— 2D. and the other half is a + 2 D. Placing this 
lens, with its axis at 180 , before the schematic eye 
at emmetropia (zero), and the observer at one meter 
distance with his plane mirror, the two light areas 



SCISSOR MOVEMENT, CONIC CORNEA, ABERRATION. 69 

characteristic of the scissor movement, with their 
comparatively straight edges and dark interspace, 
may be seen approaching each other from above and 
below (and the dark interspace disappearing) as the 
mirror is tilted in the vertical meridian. 

Figure 37 is a section of thin plane glass mounted 
as in figure 36, and has cemented at its center a 
small plano-convex sphere of three diopters, whose 
base is about four mm. in diameter. Placing this 
lens in front of the schematic eye at emmetropia, 
and reflecting the light from the plane mirror at one 
meter, there will be seen in the pupillary area a 
small central illumination, which moves against or 
opposite to the movement of the mirror, and at the 
same time there will also be seen a peripheral ring 
(at the edge of the iris) which moves rapidly with 
the movement of the mirror ; between these light 
areas is a shaded ring of feeble illumination. This 
is the retinoscopic picture and movement of the light 
areas, so indicative of conic cornea. It is also an 
exaggerated picture of negative aberration. 

Figure 38 is made similar to figure 37, except that 
at its center is ground a — 2D. sphere of about four 
mm. in diameter. To produce spheric aberration 
of the positive form, place this lens in front of the 
schematic eye at emmetropia, and the observer, 
seated at one meter distance with the plane mirror, 
will see in the pupillary area a central illumination 
which moves slower than the peripheral area or 
ring (at the edge of the iris), which moves rapidly, 
both areas moving with the movement of the mirror. 

After the observer has carefully studied these pic- 



70 RETIN0SC0PY. 

tures, it will be obvious that changes other than those 
mentioned can be made with these lenses, and he 
should proceed to note them by — 

i. Changing the focus of the schematic eye. 

2. By varying his distance from the eye. 

3. By placing both the concave and convex 
spheres in combination. 

4. By placing a concave cylinder in front of the 
double cylinder at an oblique axis, thus getting a 
picture of compound irregular astigmatism. 

5. By placing a concave cylinder in front of the 
convex sphere and developing astigmatism with the 
conic cornea, which is the usual condition ; or a con- 
vex cylinder might be used in place of the concave 
cylinder if a higher error is desired. 

6. It is obvious, also, that the scissor movement 
can be produced by a prism which is made to cover 
one-half of the pupillary area, but the resulting 
picture is not so satisfactory for demonstration as 
that given by the combination lens referred to in 



INDEX. 



ABERRATION, 27, 67, 68, 69, 

70 
Accuracy, 13, 29 
Albino, 25 
Amblyopia, 11 
Aphakia, II 
Apparatus, 12, 16, 35, 36, 37, 38, 

53 
Argand burner, 16 
Arrangement, 21, 22, 23 
Astigmatism, 47, 48, 49, 50, 51, 52, 

56, 57, 58, 61, 62 
Avoid, what to, 31, 32 
Axiom, II 
Axonometer, 52, 53, 54, 55 

BAND of light, 47, 48, 49, 50, 5 t, 

53 
Beginner, 13 
Brunette, 25 



CATOPTRIC images, 25 
Central shadow, 14, 15 
Compound irregular astigmatism, 61 
Concave mirror, 17, 65 
Conic cornea, 67, 68 
Conjugate focus, 13, 28 
Cover chimney, 16, 17, 66, 67 
Cycloplegic, 19, 64, 65 



DARK room, 17 

Definition, 9 

Dioptroscopy, 9 

Direction of movement 32, 33 

Discs, 35, 36 

Distance, 20, 21 



EMMETROPIA, 42, 43 

Examples, 29, 46 



FACIAL illumination, 29 

Fantoscopy, 9 

Far-point, 9, 28, 41, 44, 45 

Form of retinal illumination, 32, 33, 

34 
Fundus-reflex test, 9 



GENERAL appearances, 25, 26 



HOW to use the mirror, 23, 24 
Hyperopia, 39, 40, 41, 42 



ILLITERATES, II 

Illuminated area, 26 
Illumination, facial, 29 

retinal, 29, 30, 32, 33, 
34 
Illustrations, 12, 15, 16, 21, 22, 23, 

27. 34, 35, 3 6 , 39, 4Q, 41, 42, 44, 

45, 48, 49, 5o, 51- 53, 57, 58, 59, 

62, 63, 68 
Image, 26 
Images, 25 
Irregular astigmatism, 56, 57, 58, 

59, 60, 61, 62 



JACKSON, iii, 14 

Jennings, 37 



KERATOSCOPY, 9 



LENSES, 31, 34 

Lenticular astigmatism, 57, 58, 59 

Light, 15, 16 

Light-screen, 16, 17, 66, 67 



72 ] 

MACULA, 19 

Meter distance, 20, 21, 22, 32, 33 

Mirror, 14, 15, 23 

51, 52, 64 



Mixed astigmatism, 
Movement of light, 16 

mirror, 34, 35 
Mulatto, 25 
Myopia, 43, 44, 45, 46, 64 

NAME. 9 

Negative aberration, 63, 64 
Neutralizing lenses. 31. 34. 
Nystagmus, 11 



OBSERVER, 18 
Oliver, 9 

PATIENT, 19 

Point of reversal, 20, 21, 28 

to find, 2S, 29, 30, 

3 1 

Position of light, 17. iS 

mirror, 17. iS 
observer, iS 
patient, 19 

Positive aberration, 63, 64, 68, 69 

Principle of retinoscopy, 9, 10 

Punctum remotum. 45 

Pupillary area, 27 

Pupilloscopy, 9 



RATE of movement, 33, 34 
Reflection from mirror, 22, 23 

lenses, 25 
Regular astigmatism, 47, 4S, 49, 50, 

5 1 
Retinal illumination, 26 
Retinophotoscopy, 9 
Reiinoscope, 14. 15. 23 
Retinoscopy, 9 

without a cvcloplegic, 
64,65 



Retinoskiascopy, 9 

Reversal of movement, 9, 20, 21, 28, 

29, 3°. 3*. J 2 - 41, 44, 45. 62 
Room, 17 
Rules for lenses, 34 

distance. 46 



SCHEMATIC eye, 12, 65, 66 
Scissor movement, 58, 59, 60, 61, 

67, 6S 
Shade, 16 
Shadow, 26, 27 
Shadow-test, 26 
Sight-hole, 14 
Size of mirror, 14. 15 
Skiascopy, 9 
Source of light, 17, 18 
Spheric aberration, 62, 63, 64 
Squint, 19 
Suggestions to the beginner, 13 



THORINGTON, 12, 15, 16, 23, 

52. 65. 67 
Trial -frame, 38 



UMBRASCOPY, 9 



VALUE of retinoscopy, 10, 
Vision of observer, iS 



WELSBACH. 15 
What the observer sees, 25 

to avoid, 31, 32 
Where to look and what to look for, 

27 
Wiirdemann, 36 

YOUNG children, 11, 22. 55 



Catalogue No. 8. February, 1898. 

CLASSIFIED SUBJECT 
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OF 

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Chemistry, Hygiene, Etc., Etc., 

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SUBJECT. PAGE 

Alimentary Canal (see Surgery) 19 

Anatomy 3 

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Bandaging (see Surgery) 19 

Brain 4 

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Children, Diseases of 6 

Clinical Charts 6 

Compends 22, 23 

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Deformities 7 

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Diagrams (see Anatomy, page 
3, and Obstetrics, page 16). 

Dictionaries 8 

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Latin, Medical (see Miscella- 
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Lungs 12 

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Materia Medica 12 

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Microscopy 13 

M ilk Analy sis (see Chemistry) 4 

Miscellaneous 14 

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SUBJECT. PAGE 

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trations. 4 th Edition. $3.50 

TOMES. Dental Surgery. 3d Edition. 292 Illustrations. $4.00 

WARREN. Compend of Dental Pathology and Dental Medi- 
cine. With a Chapter on Emergencies. 3d Edition. Illustrated. 
Just Ready. .80; Interleaved, J1.25 

WARREN. Dental Prosthesis and Metallurgy. 129 Ills. $1.25 

WHITE. The Mouth and Teeth. Illustrated. .40 

*** Special Catalogue of Dental Books free upon application. 



8 SUBJECT CATALOGUE. 

DICTIONARIES. 

GOULD. The Illustrated Dictionary of Medicine, Biology, 
and Allied Sciences. Being an Exhaustive Lexicon of Medicine 
and those Sciences Collateral to it: Biology (Zoology and Botany), 
Chemistry, Dentistry, Parmacology, Microscopy, etc., with many 
useful Tables and numerous fine Illustrations. 1633 pages. 3d Ed. 
Sheep or Half Dark Green Leather, $10.00; Thumb Index, $11.00 
Half Russia, Thumb Index, $12.00 

GOULD. The Medical Student's Dictionary. Including all the 
Words and Phrases Generally Used in Medicine, with their Proper 
Pronunciation and Definition, Based on Recent Medical Literature. 
With Tables of the Bacilli, Micrococci, Mineral Springs, etc., of the 
Arteries, Muscles. Nerves, Ganglia, and Plexuses, etc. loth Edition. 
Rewritten and Enlarged. Completely resetfrom new tvpe. 700pp. 
Half Dark Leather, $3.25 ; Half Morocco, Thumb Index, $4.00 

GOULD. The Pocket Pronouncing Medical Lexicon. (12,000 
Medical Words Pronounced and Defined.) Containing all the Words, 
their Definition and Pronunciation, that the Medical, Dental, or 
Pharmaceutical Student Generally Comes in Contact With ; also 
Elaborate Tables of the Arteries, Muscles, Nerves, Bacilli, etc., etc., 
a Dose List in both English and Metric System, etc, Arranged in a 
Most Convenient form for Reference and Memorizing. 

Full Limp Leather, Gilt Edges, $1.00 ; Thumb Index, $1.25 
70,000 Copies of Gould's Dictionaries Have Been Sold. 
*** Sample Pages and Illustrations and Descriptive Circulars of 

Gould's Dictionaries sent free upon application. 

HARRIS. Dictionary of Dentistry. Including Definitions of Such 
Words and Phrases of the Collateral Sciences as Pertain to the Art 
and Practice of Dentistry. 5th Edition. Revised and Enlarged by 
Ferdinand J. S. Gorgas, M.D., d.d.s. Cloth, $4.50; Leather, $5.50 

LONGLEY. Pocket Medical Dictionary. With an Appendix, 
containing Poisons and their Antidotes, Abbreviations used in Pre- 
scriptions, etc. Cloth, .75 ; Tucks and Pocket, $1.00 

MAXWELL. Terminologia Medica Polyglotta. By Dr. 
Theodore Maxwell, Assisted by Others. $3-oo 

The object of this work is to assist the medical men ot any nationality 

in reading medical literature written in a language not their own. 

Each term is usually given in seven languages, viz. : English, French, 

German, Italian, Spanish, Russian, and Latin. 

TREVES AND LANG. German-English Medical Dictionary. 
Half Russia, $3.25 

EAR (see also Throat and Nose). 

HOVELL. Diseases of the Ear and Naso-Pharynx. Includ- 
ing Anatomy and Physiology of the Organ, together with the Treat- 
ment of the Affections of the Nose and Pharynx which Conduce to 
Aural Disease. 122 Illustrations. $5-°° 

BURNETT. Hearing and How to Keep It. Illustrated. .40 

DALBY. Diseases and Injuries of the Ear. 4th Edition. 38 
Wood Engravings and 8 Colored Plates. $2.50 

PRITCHARD. Diseases of the Ear. 3d Edition, Enlarged. 
Many Illustrations and Formulae. $1.50 

WOAKES. Deafness, Giddiness, and Noises in the Head. 
4th Edition. Illustrated. #2.00 



MEDICAL BOOKS. 



ELECTRICITY. 

BIGELOW. Plain Talks on Medical Electricity and Bat- 
teries. With a Therapeutic Index and a Glossary. 43 Illustra- 
tions. 2d Edition. $1.00 
JONES. Medical Electricity. 2d Edition. 112 Illustrations. $2.50 
MASON. Electricity ; Its Medical and Surgical Uses. Numer- 
ous Illustrations. .75 

EYE. 

A Special Circular of Books on the Eye sent Jree upon application. 

ARLT. Diseases of the Eye. Clinical Studies on Diseases of the 

Eye. Authorized Translation by Lyman Ware, m.d. Illustrated. 

FICK. Diseases of the Eye and Ophthalmoscopy. Trans- 
lated by A. B. Hale, m. d. 157 Illustrations, many of which are in 
colors, and a glossary. Cloth, #4.50 ; Sheep, $5.50 

GOULD AND PYLE. Compend of Diseases of the Eye and 
Refraction. Including Treatment and Operations, and a Section 
on Local Therapeutics. With Formulae, Useful Tables, a Glossary, 
and hi Illustrations, several of which are in colors. Just Ready. 

Cloth, .80; Interleaved, |i. 00 

GOWERS. Medical Ophthalmoscopy. A Manual and Atlas 
with Colored Autotype and Lithographic Plates and Wood-cuts, 
Comprising Original Illustrations of the Changes of the Eye in Dis- 
eases of the Brain, Kidney, etc. 3d Edition. $4.00 

HARLAN. Eyesight, and How to Care for It. Illus. .40 

HARTRIDGE. Refraction. 96 Illustrations and Test Types. 
8th Edition, Enlarged. $1.50 

HARTRIDGE. On the Ophthalmoscope. 3d Edition. With 
72 Colored Plates and many Wood-cuts. #1.50 

HANSELL AND BELL. Clinical Ophthalmology. Colored 
Plate of Normal Fundus and 120 Illustrations. $1.50 

MACNAMARA. On the Eye. 5th Edition. Numerous Colored 
Plates, Diagrams of Eye, Wood-cuts, and Test Types. $3-5° 

MORTON. Refraction of the Eye. Its Diagnosis and the Cor- 
rection of its Errors. With Chapter on Keratoscopy and Test 
Types. 6th Edition. $1.00 

OHLEMANN. Ocular Therapeutics. Authorized Translation, 
and Edited by Dr. Charles A. Oliver. In Press. 

PHILLIPS. Spectacles and Eyeglasses. Their Prescription 
and Adjustment 2d Edition. 49 Illustrations. gi.oo 

SWANZY. Diseases of the Eye and Their Treatment. 6th 
Edition, Revised and Enlarged. 158 Illustrations, 1 Plain Plate, 
and a Zephyr Test Card. #3.00 

THORINGTON. Retinoscopy. 2d Ed. Illus. Just Ready. $1.00 

WALKER. Students' Aid in Ophthalmology. Colored Plate 
and 40 other Illustrations and Glossary. ?i-5° 

FEVERS. 

COLLIE. On Fevers. Their History, Etiology, Diagnosis, Prog- 
nosis, and Treatment. Colored Plates. J2.00 

GOODALL AND WASHBOURN. Fevers and Their Treat- 
ment. Illustrated. $3.00 



SUBJECT CATALOGUE. 



GOUT AND RHEUMATISM. 

DUCKWORTH. A Treatise on Gout. With Chromo-lithographs 
and Engravings. Cloth, $6.00 

GARROD. On Rheumatism. A Treatise on Rheumatism and 
Rheumatic Arthritis. Cloth, $5. 00 

HAIG. Causation of Disease by Uric Acid. A Contribution to 
the Pathology of High Arterial Tension, Headache, Epilepsy, Gout, 
Rheumatism, Diabetes, Bright's Disease, etc. 4th Edition. fo.oo 



HEADACHES. 

DAY. On Headaches. The Nature, Causes, and Treatment ot 
Headaches. 4th Edition. Illustrated. Jloq 



HEALTH AND DOMESTIC MEDI- 
CINE (see also Hygiene and Nursing). 

BUCKLEY. The Skin in Health and Disease. IUus. 

BURNETT. Hearing and How to Keep It. Illustrated. 

COHEN. The Throat and Voice. Illustrated. 

DULLES. Emergencies. 4th Edition. Illustrated. $1 

HARLAN. Eyesight and How to Care for It. Illustrated. 

HARTSHORNE. Our Homes. Illustrated. 

OSGOOD. The Winter and its Dangers. 

PACKARD. Sea Air and Bathing. 

PARKES. The Elements of Health. $, 

RICHARDSON. Long Life and How to Reach It. 

WESTLAND. The Wife and Mother. ft 

■WHITE. The Mouth and Teeth. Illustrated. 

■WILSON. The Summer and its Diseases. 

WOOD. Brain Work and Overwork. 

STARR. Hygiene of the Nursery. 5th Edition. fi 

CANFIELD. Hygiene of the Sick-Room. Ji 

HEART. 

SANSOM. Diseases of the Heart. The Dia 
of Diseases of the Heart and Thoracic Aorta. 
Illustrations. $6.00 

HISTOLOGY. 

STIRLING. Outlines of Practical Histology. 368 Illustrations. 
2d Edition, Revised and Enlarged. With new Illustrations. $2.00 

STOHR. Histology and Microscopical Anatomy. Translated 
and Edited by A. Schaper, m.d., Harvard Medical School. 268 
Illustrations. $3-oo 



MEDICAL BOOKS. 11 

HYGIENE AND WATER ANALYSIS. 

Special Catalogue of Books on Hygiene sent free upon application. 

CANFIELD. Hygiene of the Sick-Room. A Book for Nurses 
and Others. Being a Brief Consideration of Asepsis, Antisepsis, Dis- 
infection, Bacteriology, Immunity, Heating and Ventilation, and 
Kindred Subjects. $1-25 

COPLIN AND BEVAN. Practical Hygiene. A Complete 
American Text-Book. 138 Illustrations. Cloth, $3.25 ; Sheep, $4.25 

FOX. Water, Air, and Food. Sanitary Examinations of Water, 
Air, and Food. 100 Engravings. 2d Edition, Revised. $3- 50 

KENWOOD. Public Health Laboratory Work. 116 Illustra- 
tions and 3 Plates. $2.00 

LEFFMANN. Examination of Water for Sanitary and 
Technical Purposes. 3d Edition. Illustrated. #1-25 

LEFFMANN. Analysis of Milk and Milk Products. Illus- 
trated. $1.25 

LINCOLN. School and Industrial Hygiene. .40 

MACDONALD. Microscopical Examinations of Water and 
Air. 25 Lithographic Plates, Reference Tables, etc. 2d Ed. $2.50 

McNEILL. The Prevention of Epidemics and the Construc- 
tion and Management of Isolation Hospitals. Numerous Plans 
and Illustrations. $3.50 

NOTTER AND FIRTH. The Theory and Practice of Hygiene. 
(Being the 9th Edition of Parkes' Practical Hygiene, rewritten and 
brought up to date.) 10 Plates and 135 other Illustrations: 1034 
pages. 8vo. $7.00 

PARKES. Hygiene and Public Health. By Louis C. Parkes, 
m.d. 5th Edition. Enlarged. Illustrated. $2.50 

PARKES. Popular Hygiene. The Elements of Health. A Book 
for Lay Readers. Illustrated. $r-25 

STARR. The Hygiene of the Nursery. Including the General 
Regimen and Feeding of Infants and Children, and the Domestic 
Management of the Ordinary Emergencies of Early Life, Massage, 
etc. 6th Edition. 25 Illustrations. £1.00 

STEVENSON AND MURPHY. A Treatise on Hygiene. By 
Various Authors. In Three Octave Volumes. Illustrated. 

Vol. I, $6.00; Vol. II, $6.00; Vol. Ill, $5.00 
*** Each Volume sold separately. Special Circular upon application. 

WILSON. Hand-Book of Hygiene and Sanitary Science. 
Wiih Illustrations. 8th Edition. Preparing. 

WEYL. Sanitary Relations of the Coal-Tar Colors. Author- 
ized Translation by Henry LEFFMANN, M.D. , PH.D. $T-*S 

*** Special Catalogue of Books on Hygiene free upon application. 

LUNGS AND PLEURA. 

HARRIS AND BEALE. Treatment of Pulmonary Consump- 
tion. $2.50 

POWELL. Diseases of the Lungs and Pleurae, including 
Consumption. Colored Plates and other Illus. 4th Ed. $4.00 

TUSSEY. High Altitudes in the Treatment of Consumption. 
Just Ready. $1.50 



SUBJECT CATALOGUE. 



MASSAGE. 

KLEEN. Hand-Book of Massage. Authorized translation by 
Mussey Hartwell, m.d., PH.D. With an Introduction by Dr. S. 
Weir Mitchell. Illustrated by a series of Photographs Made 
Especially by Dr. Kleen for the American Edition. t 2 - 2 5 

MURRELL. Massotherapeutics. Massage as a Mode of Treat- 
ment. 5th Edition. $1-25 

OSTROM. Massage and the Original Swedish Move- 
ments. Their Application to Various Diseases of the Body. A 
Manual for Students, Nurses, and Physicians. Third Edition, En- 
larged. 94 Wood Engravings, many of which are original. JSi.oo 



MATERIA MEDICA AND THERA- 
PEUTICS. 

ALLEN, HARLAN, HARTE, VAN HARLINGEN. A 
Hand-Book of Local Therapeutics, Beinga Practical Description 
of all those Agents Used in the Local Treatment of Diseases of the 
Eye, Ear, Nose and Throat, Mouth, Skin, Vagina, Rectum, etc., 
such as Ointments, Plasters, Powders, Lotions, Inhalations, Supposi- 
tories, Bougies, Tampons, and the Proper Methods of Preparing and 
Applying Them. Cloth, $3.00 ; Sheep, $4.00 

BIDDLE. Materia Medica and Therapeutics. Including Dose 
List, Dietary for the Sick, Table of Parasites, and Memoranda of 
New. Remedies. 13th Edition, Thoroughly Revised in accord- 
ance with the new U. S. P. 64 Illustrations and a Clinical Index. 
Cloth, $4.00; Sheep, $5.00 

BRACKEN. Outlines of Materia Medica and Pharmacology. By 
H. M. Bracken, University of Minnesota. $2.75 

DAVIS. Materia Medica and Prescription Writing. $150 

FIELD. Evacuant Medication. Cathartics and Emetics. $1.75 



HELLER. Essentials of Materia Medica, Pharmacy, and 
Prescription Writing. J1.00 

MAYS. Theine in the Treatment of Neuralgia. % bound, .50 
NAPHEYS. Modern Therapeutics, qth Revised Edition, En- 
larged and Improved. In two handsome volumes. Edited by Allen 
J. Smith, m.d., and J. Aubrey Davis, m.d. 

Vol. I. General Medicine and Diseases of Children. I400 

Vol.11. General Surgery, Obstetrics, and Diseases of Women. $4.00 

POTTER. Hand-Book of Materia Medica, Pharmacy, and 
Therapeutics, including the Action of Medicines, Special Therapeu- 
tics, Pharmacology, etc., including over 600 Prescriptions and For- 
mulae. 6th Edition, Revised and Enlarged. With Thumb Index in 
each copy. Cloth, $4.50; Sheep, $5.50 

POTTER. Compend of Materia Medica, Therapeutics, and 
Prescription Writing, with Special Reference to the Physiologi- 
cal Action of Drugs. 6th Revised and Improved Edition, based upon 
the U. S. P. 1890 .80 ; Interleaved, $1.25 



MEDICAL BOOKS. 13 

SAYRE. Organic Materia Medica and Pharmacognosy. An 
Introduction to the Study of the Vegetable Kingdom and the Vege- 
table and Animal Drugs. Comprising the Botanical and Physical 
Characteristics, Source, Constituents, and Pharmacopeial Prepara- 
tions. With chapters on Synthetic Organic Remedies, Insects In- 
jurious to Drugs, and Pharmacal Botany. A Glossary and 543 Illus- 
trations, many of which are original. $4.00 

WARING. Practical Therapeutics. 4th Edition, Revised and 
Rearranged. Cloth, $2.00; Leather, $3.00 

WHITE AND WILCOX. Materia Medica, Pharmacy, Phar- 
macology, and Therapeutics. 3d American Edition, Revised by 
Reynold W. Wilcox, m.a., m.d., ll.d. Clo., $2.75; Lea., $3.25 



MEDICAL JURISPRUDENCE AND 
TOXICOLOGY. 

REESE. Medical Jurisprudence and Toxicology. A Text-Book 
for Medical and Legal Practitioners and Students. 4th Edition. 
Revised by Henry Leffmann, m.d. Clo., $3.00 ; Leather, $3.50 



'* To the student of medical jurisprudence and toxicology 
valuable, as it is concise, clear, and thorough in every respect. 
American Journal of the Medical Sciences. 

MANN. Forensic Medicine and Toxicology. Illus. 



TANNER. Memoranda of Poisons. Their Antidotes and Tests. 
7th Edition. .75 

MICROSCOPY. 

BEALE. The Use of the Microscope in Practical Medicine. 

For Students and Practitioners.with Full Directions for Examining the 
Various Secretions, etc., by the Microscope. 4th Ed. 500 Illus. $6.50 

BEALE. How to Work with the Microscope. A Complete 
Manual of Microscopical Manipulation, containing a Full Description 
of many New Processes of Investigation, with Directions for Examin- 
ing Objects Under the Highest Powers, and for Taking Photographs 
of Microscopic Objects. 5th Edition. 400 Illustrations, many of 
them colored. $6.50 

CARPENTER. The Microscope and Its Revelations. 7th 
Edition. 800 Illustrations and many Lithographs. $5-5<> 

LEE. The Microtomist's Vade Mecum. A Hand-Book of 
Methods of Microscopical Anatomy. 887 Articles. 4th Edition, 
Enlarged. Just Ready. $4.00 



REEVES. Medical Microscopy, including Chapters on Bacteri- 
ology, Neoplasms, Urinary Examination, etc. Numerous Illus- 
trations, some of which are printed in colors. $2.50 

WETHERED. Medical Microscopy. A Guide to the Use of the 

Microscope in Practical Medicine. 100 Illustrations. J2.00 



14 SUBJECT CATALOGUE. 

MISCELLANEOUS. 

BLACK. Micro-Organisms. The Formation of Poisons. A 
Biological Study of the Germ Theory of Disease. .75 

BURNETT. Foods and Dietaries. A Manual of Clinical Diet- 
etics. 2d Edition. $1-50 
GOULD. Borderland Studies. Miscellaneous Addresses and 
Essays, umo. | 2 .oo 
GOWERS. The Dynamics of Life. .75 
HAIG. Causation of Disease by Uric Acid. A Contribution to 
the Pathology of High Arterial Tension, Headache, Epilepsy, Gout, 
Rheumatism, Diabetes, Blight's Disease, etc. 3d Edition. I3.00 
HARE. Mediastinal Disease. Illustrated by six Plates. $2.00 
HEMMETER. Diseases of the Stomach. Their Special Path- 
ology, Diagnosis. ani 'ireacment. With Sections on A- : - 
elks - :'. Dlosti - S : Ready. Clo. fGuoo; - t- -_,- 
HENRY. A Practical Treatise on Anemia. Half Cloth, .50 
LEFFMANN. The Coal-Tar Colors. With Special Reference "to 
their Injurious Qualities and the Restrictions of their Use. A Trans- 
lation of Theodore Wetl's Monograph. $1.25 
MARSHALL. History of Woman's Medical College of Penn- 
sylvania, fiat Ready. fi.50 
NEW SYDENHAM SOCIETY'S PUBLICATIONS. Circulars 
upon application. Per Annum, f&aa 
TREVES. Physical Education : Its Effects, Methods, Etc. .75 
LIZARS. The Use and Abuse of Tobacco. .40 
PARRISH. Alcoholic Inebriety from a Medical Standpoint, 
with Cases. Ji.oo 
ST. CLAIR. Medical Latin. $1.00 

NERVOUS DISEASES. 

BEEVOR. Diseases of the Nervous System and their Treat- 
ment. In Press. 

GORDINIER. The Gross and Minute Anatomy of the Cen- 
tral Nervous System. With mat 

f 

GOWERS. Manual of Diseases of the Nervous System. A 
. - .-.. - ...:■: 21 Edition, Revised, EfaLuged, and ia nsnj 
parts Rewritten. With many new Illustrations. Two volumes. 
Vol. I. Diseases of the Nerves and Spinal Cord. Clo. $3.00 ; Sh. $4.00 
Vol. II. Diseases of the Brain and Cranial Nerves ; General and 
Functional Disease. Cloth, $4.00 ; Sheep, $5. co 

GOWERS. Syphilis and the Nervous System. J1.00 

GOWERS. Diagnosis of Diseases of the Brain. 2d Edition. 
Illustrated. $1.50 

GOWERS. Clinical Lectures. A New Volume of Essays on the 
Diagnosis, Treatment, etc., of Diseases of the Nervous System. $2.00 

GOWERS. Epilepsy and Other Chronic Convulsive Diseases. 
2d Edition. In Press 

HORSLEY. The Brain and Spinal Cord. The Structure and 
Functions of. Numerous Illustrations. $ 2 -5° 

OBERSTEINER. The Anatomy of the Central Nervous Or- 
gans. A Guide to the Study of their Structure in Health and Dis- 
ease. io3 Illustrations. $5-5° 



MEDICAL BOOKS. 15 

ORMEROD. Diseases of the Nervous System. 66 Wood En- 
gravings. $1.00 
OSLER. Cerebral Palsies of Children. A Clinical Study. Jfe.oo 
OSLER. Chorea and Choreiform Affections. $2.00 
PRESTON. Hysteria and Certain Allied Conditions. Their 
Nature and Treatment. Illustrated. Just Ready. $2.00 
WATSON. Concussions. An Experimental Study of Lesions Aris- 
ing from Severe Concussions. Paper cover, $1.00 
WOOD. Brain Work and Overwork. .40 



NURSING. 

Special Catalogue of Books for Nurses sent free upon application. 

BROWN. Elementary Physiology for Nurses. .75 

CANFIELD. Hygiene of the Sick-Room. A Book for Nurses and 
Others. Being a Brief Consideration of Asepsis, Antisepsis, Disinfec- 
tion, Bacteriology, Immunity, Heating and Ventilation, and Kindred 
Subjects for the Use of Nurses and Other Intelligent Women. $1.25 

CULLINGWORTH. A Manual of Nursing, Medical and Sur- 
gical. 3d Edition with Illustrations. .75 

CULLINGWORTH. A Manual for Monthly Nurses. 3d Ed. .40 

CUFF. Lectures to Nurses on Medicine. 25 Illustrations. $1.00 

DOMVILLE. Manual for Nurses and Others Engaged in At- 
tending the Sick. 8th Edition. With Recipes for Sick-room Cook- 
ery, etc. .75 

FULLERTON. Obstetric Nursing. 40 Ills. 4 th Ed. $1.00 

FULLERTON. Nursing in Abdominal Surgery and Diseases 
of Women. Comprising the Regular Course of Instruction at the 
Training-School of the Women's Hospital, Philadelphia. 2d Edition. 
70 Illustrations. $1.50 

HUMPHREY. A Manual for Nurses. Including General 
Anatomy and Physiology, Management of the Sick-Room, etc. 15th 
Edition. Illustrated. $1.00 

SHAWE. Notes for Visiting Nurses, and all those Interested 
in the Working and Organization of District, Visiting, or 
Parochial Nurse Societies. With an Appendix Explaining the 
Organization and Working of Various Visiting and District Nurse So- 
cieties, by Helen C. Jenks, of Philadelphia. J1.00 

STARR. The Hygiene of the Nursery. Including the General 
Regimen and Feeding of Infants and Children, and the Domestic Man- 
agement of the Ordinary Emergencies of Early Life, Massage, etc. 6th 
Edition. 25 Illustrations. Just Ready. $1.00 

TEMPERATURE AND CLINICAL CHARTS. See page 6. 

VOSWINKEL. Surgical Nursing, in Illustrations. $1.00 

*** Special Catalogue of Books on Nursing free upon application. 



OBSTETRICS. 

BAR. Antiseptic Midwifery. The Principles of Antiseptic Meth- 
ods Applied to Obstetric Practice. Authorized Translation by 
Henry D. Fry, m.d. , with an Appendix by the Author. $1.00 



SUBJECT CATALOGUE. 



CAZEAUX AND TARNIER. Midwifery. With Appendix by 
Munde. The Theory and Practice of Obstetrics, including the Dis- 
eases of Pregnancy and Parturition, Obstetrical Operations, etc. 
8th Edition. Illustrated by Chromo-Lithographs, Lithographs, and 
other full-page Plates, seven of which are beautifully colored, and 
numerous Wood Engravings. Cloth, $4.50 ; Full Leather, $5.50 

DAVIS. A Manual of Obstetrics. Being a Complete Manual for 
Physicians and Students. 2d Edition. 16 Colored and other Plates 
and 134 other Illustrations. $2.00 

JELLETT. The Practice of Midwifery. Illustrated. gi.75 

LANDIS. Compend of Obstetrics. 5th Edition, Revised by Wm. 
H. Wells, Assistant Demonstrator of Clinical Obstetrics, Jefferson 
Medical College. With many Illustrations, .80 ; Interleaved, $1.25. 

SCHULTZE. Obstetrical Diagrams. Being a series of : 



ored Lithograph Charts, Imperial Map Size, of Pregnancy and Mid- 
by Wood Cuts. 



lpanying explanatory (German) text illustrated 



1 Sheets, $26.00 ; Mounted on Rollers, Muslin Backs, $36.00 
STRAHAN. Extra-Uterine Pregnancy. The Diagnosis and 
Treatment of Extra-Uterine Pregnancy. .75 

WINCKEL. Text-Book of Obstetrics, Including the Pathol- 
ogy and Therapeutics of the Puerperal State. Authorized 
Translation by J. Clifton Edgar, a.m., m.d. With nearly 200 Illus- 
trations. Cloth, $5.00 ; Leather, $6.00 
FULLERTON. Obstetric Nursing. 4th Ed. Illustrated. $1.00 
SHIBATA. Obstetrical Pocket-Phantom with Movable Child 
and Pelvis. Letter Press and Illustrations. $1.00 

PATHOLOGY. 

BARLOW. General Pathology. In Press. 

BLACKBURN. Autopsies. A Manual of Autopsies Designed for 
the Use of Hospitals for the Insane and other Public Institutions. 
Ten full-page Plates and other Illustrations. $1.25 

BLODGETT. Dental Pathology. By Albert N. Blodgett, 
m.d., late Professor of Pathology and Therapeutics, Boston Dental 
College. 33 Illustrations. $1.25 

COPLIN. Manual of Pathology. Includina Bacteriology, Technic 
of Post-Mortems, Methods of Pathologic Research, etc. 265 Illus- 
trations, many of which are original. 121110. Just Ready. $3.00 

GILLIAM. Pathology. A Hand-Book for Students. 47 IIlus. .75 

HALL. Compend of General Pathology and Morbid Anatomy. 
91 very fine Illustrations. .80; Interleaved, $1.25 

VIRCHOW. Post-Mortem Examinations. A Description and 
Explanation of the Method of Performing Them in the Dead House 
of the Berlin Charity Hospital, with Special Reference to Medico- 
Legal Practice. 3d Edition, with Additions. .75 

WHITACRE. Laboratory Text-Book of Pathology. With 
121 Illustrations. Just Ready. $1.50 

PHARMACY. 

Special Catalogue of Books on Pharmacy sent free upon application. 
COBLENTZ. Manual of Pharmacy. A New and Complete 

Text-Book by the Professor in the New York College of Pharmacy. 

2d Edition, Revised and Enlarged. 437IUUS. Cloth, $3.50 ; Sh., $4 50 



MEDTCAL BOOKS. 17 



BEASLEY. Book of 3100 Prescriptions. Collected from the 
Practice of the Most Eminent Physicians and Surgeons — English, 
French, and American. A Compendious History ot the Materia 
Medica, Lists of the Doses of all the Officinal and Established Pre- 
parations, an Index of Diseases and their Remedies. 7th Ed. $2.00 

BEASLEY. Druggists' General Receipt Book. Comprising 
a Copious Veterinary Formulary, Recipes in Patent and Proprietary 
Medicines, Druggists' Nostrums, etc. ; Perfumery and Cosmetics, 
Beverages, Dietetic Articles and Condiments, Trade Chemicals, 
Scientific Processes, and an Appendix of Useful Tables. 10th Edi- 
tion, Revised. $2.00 

BEASLEY. Pocket Formulary. A Synopsis of the British and 
Foreign Pharmacopoeias. Comprising Standard and Approved 
Formulae for the Preparations and Compounds Employed in Medical 
Practice, nth Edition. $2.00 

PROCTOR. Practical Pharmacy. Lectures on Practical Phar- 
macy. With Wood Engravings and 32 Lithographic Fac-simile 
Prescriptions. 3d Edition, Revised, and with Elaborate Tables of 
Chemical Solubilities, etc. fo.oo 

ROBINSON. Latin Grammar of Pharmacy and Medicine. 
2d Edition. With elaborate Vocabularies. |i-75 

SAYRE. Organic Materia Medica and Pharmacognosy. An 
Introduction to the Study of the Vegetable Kinedom and the Vege- 
table and Animal Drugs. Comprising the Botanical and Physical 
Characteristics, Source, Constituents, and Pharmacopeial Prepar- 
ations. With Chapters on Synthetic Organic Remedies, Insects 
Injurious to Drugs, and Pharmacal Botany. A Glossary and 543 
Illustrations, many of which are original. Cloth, #4.00 ; Sheep, $5.00 

SCOVILLE. The Art of Compounding. Second Edition, Re- 
vised and Enlarged. Just Ready. Cloth, $2.50; Sheep, #3. 50 

STEWART. Compend of Pharmacy. Based upon " Reming- 
ton's Text-Book of Pharmacy." 5th Edition, Revised in Accord- 
ance with the U. S. Pharmacopoeia, 1890. Complete Tables of 
Metric and English Weights and Measures. .80; Interleaved, $1.25 

UNITED STATES PHARMACOPOEIA. 1890. 7 th Decennial 
Revision. Cloth, J2.50 (postpaid, $2.77); Sheep, #3.00 (postpaid, 
$3.27); Interleaved, $4.00 (postpaid, $4.50); Printed on one side ot 
page only, unbound, $3.50 (postpaid, $3.90). 

Select Tables from the U. S. P. (1890). Being Nine of the Most 
Important and Useful Tables, Printed on Separate Sheets. Care- 
fully put up in patent envelope. .25 

POTTER. Hand-Book of Materia Medica, Pharmacy, and 
Therapeutics. 600 Prescriptions and Formulae. 6th Edition. 

Cloth, $4.50; Sheep, $5.50 

*** Special Catalogue of Books on Pharmacy free upon application. 



PHYSICAL DIAGNOSIS. 

FENWICK. Medical Diagnosis. 8th Edition. Rewritten and 
very much Enlarged. 135 Illustrations. Cloth, $2.50 

TYSON. Hand-Book of Physical Diagnosis. For Students and 
Physicians. By the Professor of Clinical Medicine in the University 
of Pennsylvania. Illus. 3d Ed., Improved and Enlarged, hi Press. 

MEMMINGER. Diagnosis by the Urine. 23 Illus. $1.00 



18 SUBJECT CATALOGUE. 



PHYSIOLOGY. 

BRUBAKER. Compend of Physiology. 8th Edition, Revised 
and Enlarged. Illustrated. .80; Interleaved, $1.25 

KIRKE. Physiology. (14th Authorized Edition. Dark-Red Cloth.) 
A Hand-Book of Physiology. 14th Edition, Revised and Enlarged. 
By Prof. W. D Halliburton, of Kings College, London. 66r 
Illustrations, some of which are printed in colors. 

Cloth, JS3.00; Leather, $3.25 

LANDOIS. A Text-Book of Human Physiology, Including 
Histology and Microscopical Anatomy, with Special Reference to 
the Requirements of Practical Medicine. 5th American, translated 
from the 9th German Edition, with Additions by Wm. Stirling, 
m.d.,d.sc. 845 Ulus., many of which are printed in colors. In Press. 

STARLING. Elements of Human Physiology. 100 Ills. $1.00 

STIRLING. Outlines of Practical Physiology. Including 
Chemical and Experimental Physiology, with Special Reference to 
Practical Medicine. 3d Edition. 289 Illustrations. $2.00 

TYSON. Cell Doctrine. Its History and Present State. $1.50 

YEO. Manual of Physiology. A Text-Book for Students of 
Medicine. By Gerald F. Yeo, m.d., f.r.c.s. 6th Edition. 254 
Illustrations and a Glossary. Cloth, $2.50 ; Leather, $3.00 

PRACTICE. 

BEALE. On Slight Ailments; their Nature and Treatment. 

2d Edition, Enlarged and Illustrated. $1.25 

CHARTERIS. Practice of Medicine. 6th Edition. $2.00 

FOWLER. Dictionary of Practical Medicine. By various 

writers. An Encyclopedia of Medicine. Clo., $3.00; Half Mor. J4.00 

HUGHES. Compend of the Practice of Medicine. 5th Edition, 

Revised and Enlarged. 

Part I. Continued, Eruptive, and Periodical Fevers, Diseases of the 
Stomach, Intestines, Peritoneum, Biliary Passages, Liver, Kid- 
neys, etc., and General Diseases, etc. 
Part II. Diseases of the Respiratory System, Circulatory System, 
and Nervous System; Diseases of the Blood, etc. 

Price of each part, .80; Interleaved, $1.25 
Physician's Edition. In one volume, including the above two 
parts, a Section on Skin Diseases, and an Index. 5th Revised, 
Enlarged Edition. 568 pp. Full Morocco, Gilt Edge, $2.25 

ROBERTS. The Theory and Practice of Medicine. The 
Sections on Treatment are especially exhaustive. 9th Edition, 
with Illustrations. Cloth, $4.50 ; Leather, $5.50 

TAYLOR. Practice of Medicine. Cloth, $2.00 ; Sheep, $2.50 

TYSON. The Practice of Medicine. By James Tyson, m.d., 
Professor of Clinical Medicine in the University of Pennsylvania. 
A Complete Systematic Text-book with Special Reference to Diag- 
nosis and Treatment. Illustrated. 8vo. 

Cloth, $s. 50; Leather, $6. 50; Half Russia, $j. 50 

PRESCRIPTION BOOKS. 

BEASLEY. Book of 3100 Prescriptions. Collected from the 
Practice of the Most Eminent Physicians and Surgeons — English, 
French, and American. A Compendious History of the Materia, 
Medica, Lists of the Doses of all Officinal and Established Prepara- 
tions, and an Index of Diseases and their Remedies. 7th Ed. $2.00 



MEDICAL BOOKS. 19 

BEASLEY. Druggists' General Receipt Book. Comprising 
a Copious Veterinary Formulary, Recipes in Patent and Proprie- 
tary Medicines, Druggists' Nostrums, etc. ; Perfumery and Cos- 
metics, Beverages, Dietetic Articles and Condiments, Trade Chem- 
icals, Scientific Processes, and an Appendix of Useful Tables, 
ioth Edition, Revised. $2.00 

BEASLEY. Pocket Formulary. A Synopsis of the British and 
Foreign Pharmacopoeias. Comprising Standard Formulae for the 
various Preparations and Compounds, nth Edition. Cloth, $2.00 

PEREIRA. Prescription Book. Containing Lists of Phrases 
and Abbreviations Used in Prescriptions, Grammatical Construction 
of Prescriptions, etc. 16th Edition. Cloth, .75 ; Tucks, J1.00 

WYTHE. Dose and Symptom Book. Containing the Doses and 

Uses of all the Principal Articles of the Materia Medica. 17th Ed. 

Cloth, .75 ; Leather, with Tucks and Pocket, $1.00 

SKIN. 

BULKLEY. The Skin in Health and Disease. Illustrated. .40 
CROCKER. Diseases of the Skin. Their Description, Pathol- 
ogy, Diagnosis, and Treatment, with Special Reference to the Skin 
Eruptions of Children. 92 Illus. 2d Edition. Cloth, #4. 50; Sh., $5.50 
IMPEY. Leprosy. 37 Plates. 8vo. $3.50 

SCHAMBERG. Diseases of the Skin. Illustrated. Being No. 
16 ?Quiz-Compend? Series. Cloth, .80; Interleaved, $1. 25 

VAN HARLINGEN. On Skin Diseases. A Practical Manual 
of Diagnosis and Treatment, with special reference to Differential 
Diagnosis. 3d Edition, Revised and Enlarged. With Formulae 
and 60 Illustrations, some of which are printed in colors. $2.75 

SURGERY AND SURGICAL DIS- 
EASES. 



DEAVER. Appendicitis, Its Symptoms, Diagnosis, Pathol- 
ogy, Treatment, and Complications. Elaborately Illustrated 
with Colored Plates and other Illustrations. Cloth, $3.50 

DEAVER. Surgical Anatomy. With 200 Illustrations, Drawn by a 
Special Artist from Directions made for the Purpose. In Preparation. 

DULLES. What to Do First in Accidents and Poisoning. 
5th Edition. New Illustrations. J1.00 

HACKER. Antiseptic Treatment of Wounds, According to 
the Method in Use at Professor Billroth's Clinic, Vienna. .50 

HAMILTON. Lectures on Tumors, from a Clinical Stand- 
point. Third Edition, Revised, with New Illustrations. In Press. 

HEATH. Minor Surgery and Bandaging, ioth Ed., Revised 
and Enlarged. 158 Illustrations, 62 Formulae, Diet List, etc. $1.25 

HEATH. Injuries and Diseases of the Jaws. 4th Edition. 
187 Illustrations. $4.50 

HEATH. Lectures on Certain Diseases of the Jaws. 64 Illus- 
trations. Boards, .50 

HORWITZ. Compend of Surgery and Bandaging, including 
Minor Surgery, Amputations, Fractures, Dislocations, Surgical Dis- 
eases, and the Latest Antiseptic Rules, etc., with Differential Diagno- 
sis and Treatment. 5th Edition, very much Enlarged and Rear- 
ranged. 167 Illustrations, 98 Formulae. Clo., .80 ; Interleaved, $1.25 



SUBJECT CATALOGUE. 



JACOBSON. Operations of Surgery. Over 200 Illustrations. 

Cloth, $3.00 ; Leather, $4.00 

JACOBSON. Diseases of the Male Organs of Generation. 

88 Illustrations. $6.00 

MACREADY. A Treatise on Ruptures. 24 Full-page Litho- 
graphed Plates and Numerous Wood Engravings. Cloth, $6.00 
MAYLARD. Surgery of the Alimentary Canal. 134 lllus. $7.50 
MOULLIN. Text-Book of Surgery. With Special Reference to 
Treatment. 3d American Edition. Revised and edited by John B. 
Hamilton, m.d., ll.d., Professor of the Principles of Surgery and 
Clinical Surgery, Rush Medical College, Chicago. 623 Illustrations, 
over 200 of which are original, and many of which are printed in 
colors. Handsome Cloth, $6.00 ; Leather, $7.00 
" The aim to make this valuable treatise practical by giving special 
attention to questions of treatment has been admirably carried out. 
Many a reader will consult the work with a feeling of satisfaction that 
his wants have been understood, and that they have been intelligently 
met." — The American Journal of Medical Science. 
ROBERTS. Fractures of the Radius. A Clinical and Patho- 
logical Study. 33 Illustrations. $1.00 
SMITH. Abdominal Surgery. Being a Systematic Description 01 
all the Principal Operations. 224 lllus. 6th Ed. 2 Vols. Clo., $10.00 
SWAIN. Surgical Emergencies. Fifth Edition. Cloth, $1.75 
VOSWINKEL. Surgical Nursing, in Illustrations. $1 



WALSHAM. Manual of Practical Surgery. 5th Ed., Re- 
vised and Enlarged. With 380 Engravings. Clo., $2.00; Lea., $2.50 

WATSON. On Amputations of the Extremities and Their 
Complications. 250 Illustrations. $5.50 

THROAT AND NOSE (see also Ear). 
COHEN. The Throat and Voice. Illustrated. .40 

HALL. Diseases of the Nose and Throat. Two Colored 

Plates and 59 Illustrations. $2.50 

HUTCHINSON. The Nose and Throat. Including the Nose, 

Naso-Pharynx, Pharynx, and Larynx. Illustrated by Lithograph 

Plates and 40 other Illustrations. 2d Edition. In Press. 

MACKENZIE. The Pharmacopoeia of the London Hospital 

for Diseases of the Throat. 5th Edition, Revised by Dr. F. 

G. Harvey. $1.00 

McBRIDE. Diseases of the Throat, Nose, and Ear. A Clinical 

Manual. With colored lllus. from original drawings. 2d Ed. $6.00 
POTTER. Speech and its Defects. Considered Physiologically, 

Pathologically, and Remedially. £1.00 

WOAKES. Post-Nasal Catarrh and Diseases of the Nose 

Causing Deafness. 26 Illustrations. $1.00 

URINE AND URINARY ORGANS. 

ACTON. The Functions and Disorders of the Reproductive 
Organs in Childhood, Youth, Adult Age, and Advanced Life, 
Considered in their Physiological, Social, and Moral Relations. 
8th Edition. $1.75 

ALLEN. Albuminous and Diabetic Urine. lllus. £2.25 



MEDICAL BOOKS. 21 

BROCKBANK. Gall Stones. $2.25 

BEALE. One Hundred Urinary Deposits. On eight sheets, 
for the Hospital, Laboratory, or Surgery. Paper, $2.00 

HOLLAND. The Urine, the Gastric Contents, the Common 
Poisons, and the Milk. Memoranda, Chemical and Microscopi- 
cal, for Laboratory Use. Illustrated and Interleaved. 5th Ed. $1.00 
MEMMINGER. Diagnosis by the Urine. 23 Illus. $1.00 

MOULLIN. Enlargement of the Prostate. Its Treatment and 
Radical Cure. Illustrated. gi.50 

THOMPSON. Diseases of the Urinary Organs. 8th Ed. $3.00 
TYSON. Guide to Examination of the Urine. For the Use of 
Physicians and Students. With Colored Plate and Numerous Illus- 
trations engraved on wood. 9th Edition, Revised. $1-25 
VAN NUYS. .Chemical Analysis of Healthy and Diseased 
Urine, Qualitative and Quantitative. 39 Illustrations. $1.00 



VENEREAL DISEASES. 

Edition, Enlarged and Illustrated with 

GOWERS. Syphilis and the Nervous System. 1.00 

JACOBSON. Diseases of the Male Organs of Generation. 88 

Illustrations. $6.00 

VETERINARY. 

ARMATAGE. The Veterinarian's Pocket Remembrancer. 

Being Concise Directions for the Treatment of Urgent or Rare Cases, 
Embracing Semeiology, Diagnosis, Prognosis, Surgery, Treatment, 
etc. 2d Edition. Boards, $1.00 

BALLOU. Veterinary Anatomy and Physiology. 29 Graphic 
Illustrations. .80; Interleaved, $1.25 

TUSON. Veterinary Pharmacopoeia. Including the Outlines of 
Materia Medica and Therapeutics. 5th Edition. $2.25 



WOMEN, DISEASES OF. 

BYFORD (H. T.). Manual of Gynecology. Second Edition, 
Revised and Enlarged by 100 pages. With 341 Illustrations, many 
of which are from original drawings. Just Ready. $300 

BYFORD (W. H.). Diseases of Women. 4 th Edition. 306 
Illustrations. Cloth, #2.00 

DUHRSSEN. A Manual of Gynecological Practice. 105 
Illustrations. >i. 5 o 

LEWERS. Diseases of Women. 146 Illus. 5th Ed. In Press. 

WELLS. Compend of Gynecology. Illus. .80; Interleaved, $1. 25 

WINCKEL. Diseases of Women. Translated by special authority 
of Author, under the Supervision of, and with an Introduction by, 
Theophilus Parvin, m.d. 152 Engravings on Wood. 3d Edition, 
Revised. In Preparation. 

FULLERTON. Nursing in Abdominal Surgery and Diseases 
of Women. 2d Edition. 70 Illustrations. $1.50 



SUBJECT CATALOGUE. 



COMPENDS. 



From The Southern Clinic. 

" We know of no series of books issued by any house that so fully 
meets our approval as these ? Quiz-Compends?. They are well ar- 
ranged, full, and concise, and are really the best line of text-books that 
could be found for either student or practitioner." 



BLAKISTON'S ? QUIZ-COMPENDS? 

The Best Series of Manuals for the Use of Students. 
Price ol each, Cloth, .80. Interleaved, for taking Notes, $1.25. 

43 s " These Compends are based on the most popular text-books 
and the lectures of prominent professors, and are kept constantly re- 
vised, so that they may thoroughly represent the present state of the 
subjects upon which they treat. 

4£g» The authors have had large experience as Quiz-Masters and 
attaches of colleges, and are well acquainted with the wants of students. 

.93* They are arranged in the most approved form, thorough and 
concise, containing over 600 fine illustrations, inserted wherever they 
could be used to advantage. 

.83" Can be used by students ot any college. 

43* They contain information nowhere else collected in such a 
condensed, practical shape. Illustrated Circular free. 

No. 1. POTTER. HUMAN ANATOMY. Fifth Revised and 
Enlarged Edition. Including Visceral Anatomy. Can be used 
with either Morris's or Gray's Anatomy. 117 Illustrations and 16 
Lithographic Plates of Nerves and Arteries, with Explanatory 
Tables, etc. By Samuel O. L. Potter, m.d., Professor of the 
Practice of Medicine, Cooper Medical College, San Francisco ; late 
A. A. Surgeon, U. S. Army. 

No. 2. HUGHES. PRACTICE OF MEDICINE. Part I. Fifth 
Edition, Enlarged and Improved. By Daniel E. Hughes, m.d., 
Physician-in-Chief, Philadelphia Hospital, late Demonstrator ot 
Clinical Medicine, Jefferson Medical College, Phila. 



and Revised. By A. P. Brubaker, m.d., Professor of Physiology 
and General Pathology in the Pennsylvania College of Dental 
Surgery ; Demonstrator of Physiology, Jefferson Medical College, 
Philadelphia. 

No. 5. LANDIS. OBSTETRICS. Fifth Edition. By Henry G. 
Landis, m.d. Revised and Edited by Wm. H. Wells, m.d., 
Assistant Demonstrator of Obstetrics, Jefferson Medical College, 
Philadelphia. Enlarged. 47 Illustrations. 

No. 6. POTTER. MATERIA MEDICA, THERAPEUTICS, 
AND PRESCRIPTION WRITING. Sixth Revised Edition 
(XJ. S. P. 1890). By Samuel O. L. Potter, m.d., Professor of 
Practice, Cooper Medical College, San Francisco ; late A. A. Sur- 
geon, U. S. Army. 



MEDICAL BOOKS. 



PQUIZ-COMPENDS ?— Continued. 

No. 7. WELLS. GYNECOLOGY. A New Book. By Wm. 

H. Wells, m d., Assistant Demonstrator of Obstetrics, JeffersoD 
College, Philadelphia. 150 Illustrations. 

No. 8. GOULD AND PYLE. DISEASES OF THE EYE 
AND REFRACTION. A New Book. Including Treatment 
and Surgery, and a Section on Local Therapeutics. By George 
M. Gould, m.d., and W. L. Pyle, m.d. With Formulae, Glossary, 
Tables, and ill Illustrations, several of which are Colored. 

No. 9. HORWITZ. SURGERY, Minor Surgery, and Bandag- 
ing. Fifth Edition, Enlarged and Improved. By Orville 
Horwitz, B.S-, m.d., Clinical Professor of Genito-Urinary Surgery 
and Venereal Diseases in Jefferson Medical College ; Surgeon to 
Philadelphia Hospital, etc. With 98 Formulae and 71 Illustrations. 

No. 10. LEFFMANN. MEDICAL CHEMISTRY. Fourth 

Edition. Including Urinalysis, Animal Chemistry, Chemistry of 
Milk, Blood, Tissues, the Secretions, etc. By Henry Leffmann, 
m.d., Professor of Chemistry in Pennsylvania College of Dental 
Surgery and in the Woman's Medical College, Philadelphia. 

No. II. STEWART. PHARMACY. Fifth Edition. Based upon 
Prof. Remington's Text-Book of Pharmacy. By F. E. Stewart, 
m.d., ph.g., late Quiz-Master in Pharmacy and Chemistry, Phila- 
delphia College of Pharmacy ; Lecturer at Jefferson Medical 
College. Carefully revised in accordance with the new U. S. P. 

No. 12. BALLOU. VETERINARY ANATOMY AND PHY- 
SIOLOGY. Illustrated. By Wm. R. Ballou, m.d., Professor 
of Equine Anatomy at New York College of Veterinary Surgeons; 
Physician to Bellevue Dispensary, etc. 29 graphic Illustrations. 

No. 13. WARREN. DENTAL PATHOLOGY AND DEN- 
TAL MEDICINE. Third Edition, Illustrated. Containing 
a Section on Emergencies. By Geo. W. Warren, d.d.s., Chief 
of Clinical Staff, Pennsylvania College of Dental Surgery. 



of Diseases of Children, Chicago Medical College. 

No. 15. HALL. GENERAL PATHOLOGY AND MORBID 
ANATOMY. 91 Illustrations. By H. Newberry Hall, ph.g., 

m.d., late Professor of Pathology, Chicago Post-Graduate Medi- 
cal School. 

No. 16. DISEASES OF THE SKIN. By Jay T. Schamberg, 
m.d., Instructor in Skin Diseases, Philadelphia Polyclinic. Illus. 

Price, each, Cloth, .80. Interleaved, for taking Notes, $1.25. 

In preparing, revising, and improving Blakiston's f Quiz-Com- 
pends ? the particular wants of the student have always been kept in 
mind. 

Careful attention has been given to the construction of each s 
and while the books will be found to 
knowledge in small space, they will likewise be found easy reading; 
there is no stilted repetition of words ; the style is clear, lucid, and dis- 
tinct. The arrangement of subjects is systematic and thorough ; there 
is a reason for every word. They contain over 600 illustrations. 



Tyson's 
Practice of 
Medicine, sisz. 



Text-Book of the Practice of Medi- 
cine. With Special Reference to Diagnosis 
and Treatment. By James Tyson, m. d., 
Professor of Clinical Medicine in the Univer- 
sity of Pennsylvania; Physician to the Hos- 
pital of the University and to the Philadelphia 
Hospital ; Fellow of the College of Physicians 
of Philadelphia, etc. 



With Many Useful Illustrations. 

Octavo. 1180 Pages. 

Cloth, $5.50: Sheep, $6.50; Half Russia, $7.50. 



Extracts from a Review in the Atnerican Journal of 
Medical Sciences, March, 1897: 

" Externally it is the largest and handsomest single volume 
on the practice of medicine." 

" Clinical features are usually described in a masterly way." 

"The directions (for treatment) are full and clear, and as 
a rule, eminently judicious and conservative." 

"Dr. Tyson's style is already so well known in medical 
literature that it is only necessary to say the present work is 
one of the best examples." 

"We welcome Dr. Tyson's Practice as a most valuable 
addition to medical literature." 

Descriptive circular and sample pages upon application. 



